Although mid-urethral sling surgery in female patients with stress urinary incontinence (SUI) is proved as a simple and safe procedure with high treatment success rate, its complication rate is increasing with the growing number of the surgical cases. The present study aims to investigate and assess the complications occurred from 982 cases of mid-urethral sling surgeries that require surgical correction or intervention.

Among 1,029 patients who underwent mid-urethral sling surgery (792 tension-free vaginal tape (TVT) cases and 237 transobturator tape (TOT) cases) in our department from 2002 to 2016, 982 patients who were able to be tracked by medical records were included in the study. The medical records of the 982 patients were reviewed to investigate the complications occurred from mid-urethral sling surgeries that required surgical correction or intervention. As well, the treatment options selected for each complication cases were assessed.

The investigated complications which required surgical correction or intervention after mid-urethral sling surgery were as follows: 1 vessel injury (0.10%), 1 peri-obturator foramen abscess (0.10%), 3 vaginal erosions (0.31%), and 12 lower urinary tract symptoms (1.22%). In the case of vessel injury, the surrounding vessel of obturator artery was injured by the trocar insertion during TVT. The vessel injury was detected directly after the sling insertion and was managed by angioembolization. The peri-obturator foramen abscess occurred at 5 months after TOT, and it was managed by antibiotics along with aspiration of abscess via anterior vaginal wall without mesh removal. All vaginal erosion cases were treated by removing the exposed mesh along with repairing the incision of the anterior vaginal wall which was made for mesh removal. The 9 cases of voiding difficulty (0.92%) and the 3 cases with de novo storage symptoms which were drug-refractory (0.31%) were also treated by mesh removal. According to the medical records, there were no nerve injuries nor organ injuries.

According to our results, only 1.73% of the patients who underwent midurethral sling surgery experienced postoperative complication which required surgical correction. Among the complications, voiding difficulty which was managed by mesh removal was most commonly occurred (0.92%). All the complications were able to be managed by simple procedures and no severe complications were reported in almost a thousand TVT or TOT cases. Such results imply that midurethral sling surgery is a safe procedure to treat females with SUI.

The complications following the mid-urethral sling surgeries such as vessel injury, peri-obturator foramen abscess, vaginal erosion, and voiding difficulty could effectively be managed by intervention or mesh removal. The surgeons should always be aware of the possibility of severe complications and be prepared for valid management method for each complication.