Management of Mid-Urethral Sling complications involving the urinary tract: A regional experience 2016-2018.

Dooher M1, Saidan D2, Guerrero K2, Granitsiotis P1

Research Type

Clinical

Abstract Category

Urethra Male / Female

Abstract 722
Non Discussion Abstracts
Scientific Non Discussion Abstract Session 36
Fistulas Grafts: Synthetic Female
1. Western General Hospital, Edinburgh, 2. Queen Elizabeth Hospital, Glasgow
Links

Abstract

Hypothesis / aims of study
The surgical treatment of stress urinary incontinence (SUI) and pelvic organ prolapse (POP) has increased over the last twenty years from 11% in 1997 to an average of 20% at present after all conservative measures have failed.  The European Association of Urology guidelines recommend Mid-Urethral Sling (MUS) in women with uncomplicated SUI as the preferred option of surgical treatment.  The Independent Review of transvaginal mesh implants was set up by the Scottish government in 2015 to assess the evidence relating to surgery using synthetic mesh implants for the treatment of stress urinary incontinence (SUI) and pelvic organ prolapse (POP).  The management of the complications of MUS insertion has been centralised as a result of the review. The current study aimed to assess the urological complications associated with the mid-urethral synthetic slings and the outcome of any subsequent management or procedures.
Study design, materials and methods
A review and analysis of the logbook, theatre log and multidisciplinary team (MDT) discussion identified those patients who underwent surgical management of International Continence Society(ICS)/International Urogynaecological Association (IUGA) category 4 complications (urinary tract).  The other ICS/IUGA complication classifications were assessed including presentation of complication, surgery used for treatment and post-operative outcomes. Information based on original indication for surgery, surgeons involved, the type of complication and their presentation were all recorded.  The subsequent treatment for the complications and the outcomes of these treatments have been assessed and recorded and as well as quality of life indicators.
Results
From January 2016 to January 2018 there are have 20 patients treated in the tertiary centre for mesh complications. 100 % presented with complications more than 12 months following insertion (T4 category) with 90% (18/20 being inserted by regional gynaecologists compared with 10% (2/20) of urologists. 70% (14/20) of the complications were urethral perforations with 86% (12/14) being treated with surgical repair and the remaining cases with LASER.  The remaining 30% (6/20) were bladder perforations with 66.6% (4/6) being surgically repaired and the remaining 33.3% (2/6) undergoing LASER.  Post-operatively, 50% of patients (10/20) had mild – moderate OAB incontinence treated by physiotherapy while 10% (2/20) have undergo further anti-incontinence surgery.
Interpretation of results
The number of cases of urological complications from synthetic sling insertion are rising and this snapshot only captures work from the last two years from an experienced urologist began a new practice within this particular centre.  Given the complexity of the surgery and that the most successful outcomes are achieved by surgical management, cases should be managed centrally.
Concluding message
The complications associated with MUS insertion should be classified appropriately according to the ICS/IUGA system and managed in the centralised centre with experience to ensure long-term satisfactory outcomes.
Disclosures
Funding None Clinical Trial No Subjects Human Ethics not Req'd Retrospective review Helsinki Yes Informed Consent Yes
27/03/2024 16:15:51