The Indication and Surgical Treatment of 286 Midurethral Synthetic Sling Complications: A Multicenter Study

Abstract:

Introduction and Hypothesis: 1) Evaluate the most common indication for sling removal in patients with synthetic mesh slings; 2) identify the location of pain for each of the three types of synthetic sling procedures including retropubic (RP) sling, transobturator (TOT) sling, and single incision slings (SIS), and 3) describe the surgical approach to each of the above and its associated complications. Materials and Methods: A retrospective chart review of all patients who underwent surgical removal of a sling due to a mesh-related complications from 2011 to 2013 at three referral centers. Results: There were 337 sling complications followed by the IUGA/ICS mesh complication classification. RP slings were more likely to have urinary tract complications (category 4) and intra-abdominal site complications (S5). Of those, 286 slings were removed, 106 (37.1%) were RP, 131 (45.8%) TOT, and 44 (15.4%) SIS. Vaginal pain was the most common reason for sling removal. Twenty-one percent of the TOT had groin pain which was a five times higher risk than RP (OR 5.3, 95% CI 1.5–18.7), and the RP was three times more likely to have suprapubic pain than the TOT (OR 2.97, 95% CI 1.3–7.0). Fifteen percent of the TOT had either unilateral or bilateral groin mesh removal. Conclusion: The most common indication for sling removal was vaginal pain. RP sling had a higher risk of suprapubic pain and TOT sling had a higher risk of groin pain. Patients with a history of SIS had a higher incidence of urethral erosion. TOT removal had the highest intraoperative complication rate.

Authors:

Orawee Chinthakanan, MD, MPH, International Urogynecology Associates, Atlanta, Georgia and Beverly Hills, California, Clinical Instructor, Department of Obstetrics and Gynecology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand, John R. Miklos, MD, Director, International Urogynecology Associates, Atlanta, Georgia and Beverly Hills, California, Robert D. Moore, DO, Director, Advanced Pelvic Surgery, Atlanta, Georgia, Deborah R. Karp, MD, Assistant Professor, Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Gynecology and Obstetrics, Emory University, Atlanta, Georgia, Gladys M. Nogueiras, MD, Department of Gynecology, Section of Urogynecology and Reconstructive Pelvic Surgery, Cleveland Clinic Florida, Weston, Florida, G. Willy Davila, MD, Chairman, Department of Gynecology, Section of Urogynecology and Reconstructive Pelvic Surgery, Cleveland Clinic Florida, Weston, Florida

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