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Introduction
Many patients experience significant complications associated with transvaginal slings used to treat stress urinary incontinence (SUI). Besides mesh exposure, patients can develop recurrent UTIs, pain syndromes, dyspareunia, and voiding dysfunction long after the initial surgery. Conventional thinking has been to treat these complications conservatively with minimal disruption to the mesh in order to prevent voiding dysfunction. However, many patients do not improve with conservative measures and ultimately undergo multiple revision surgeries.
Hypothesis
The objective of this study is to evaluate the functional outcomes after surgical excision of the midurethral sling.
Materials / Methods:
A retrospective case series of patients who underwent transvaginal mesh removal to treat symptoms attributed to initial SUI procedures were analyzed.
Results
31 patients underwent transvaginal sling excision. Mean operative time was 96 minutes. Average patient age was 50 years old and average BMI was 33.
Preoperatively, two patients reported isolated urinary symptoms with the rest having documented complaints of pelvic pain, dyspareunia, and recurrent UTIs.
Reduction in self-reported pain (p=0.0352) following urethrolysis was observed while finding no evidence of voiding dysfunction (p=0.8036). Increased age had a less favorable outcome as it related to pain though the p-value was not quite significant (p=0.055). People with higher BMI’s had better outcomes with respect to pain (p=0.0081). Voiding dysfunction was unaffected by age (p=0.6913) and BMI (p=0.8703).
Conclusions
Transvaginal mesh excision (urethrolysis) relieves pain syndromes related to prior midurethral sling procedures without exacerbating voiding dysfunction. Urethrolysis should be considered a treatment option in this patient population.