A retrospective multicenter study on outcomes after midurethral polypropylene sling revision for voiding dysfunction

Stephanie Molden, Jessica Bracken, Aimee Nguyen, Heidi S. Harvie, Amanda White, Sarah L. Hammil, Danielle Patterson, Megan Tarr, Tatiana Sanses, Miles Murphy, Rebecca G. Rogers

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Objectives: The purpose of this study was to determine outcomes of sling revision after midurethral sling (MUS) placement and whether timing of sling revision affected those outcomes. Materials and Methods: This is a multicenter study including patients who underwent MUS placement and subsequent sling revision secondary to voiding dysfunction. Diagnostic outcomes before and after sling revision were compared for all sling revision patients with complete data. Logistic regression analyses were performed to determine if revision timing predicted voiding dysfunction and stress incontinence. Results: One hundred seventy-five patients who met the study criteria had complete data. Overall, 70% (133) of MUS were retropubic and 30% (56) were obturator slings. Midurethral sling revision was accomplished by cutting (54%), excision (29%), and pulling down on the mesh (18%). Stress urinary incontinence (SUI) resolved in 38%, urinary tract infections (UTIs) in 69%, and overactive bladder (OAB) in 75%. In comparison, 21% experienced de novo SUI; 18%, de novo UTIs; and 12%, de novo OAB symptoms after revision. Voiding dysfunction resolved in 80%, however 10% experienced new voiding dysfunction symptoms. Retropubic slings displayed more voiding dysfunction, higher de novo/worsened OAB, and more UTIs after revision than obturator slings. Sling revision timing did not predict persistent voiding dysfunction but did predict SUI with earlier revision (≤2 weeks) resulting in less postrevision SUI when compared to revisions at 15-90 days or greater than 90 days. The method of sling revision (cut, excised, pulled down) did not predict SUI, OAB, or obstructive voiding symptoms. Conclusions: Sling revision resolves voiding dysfunction symptoms, UTIs and post-sling OAB symptoms in the majority of patients. Resolution of voiding dysfunction is independent of method and timing of revision; however earlier revision is associated with decreased postrevision SUI.

Original languageEnglish (US)
Pages (from-to)340-344
Number of pages5
JournalFemale Pelvic Medicine and Reconstructive Surgery
Volume16
Issue number6
DOIs
StatePublished - 2010

Fingerprint

Suburethral Slings
Stress Urinary Incontinence
Polypropylenes
Overactive Urinary Bladder
Multicenter Studies
Retrospective Studies
Urinary Tract Infections
Logistic Models
Regression Analysis

Keywords

  • Midurethral slings
  • Sling revision
  • Voiding dysfunction

ASJC Scopus subject areas

  • Surgery
  • Urology
  • Obstetrics and Gynecology

Cite this

A retrospective multicenter study on outcomes after midurethral polypropylene sling revision for voiding dysfunction. / Molden, Stephanie; Bracken, Jessica; Nguyen, Aimee; Harvie, Heidi S.; White, Amanda; Hammil, Sarah L.; Patterson, Danielle; Tarr, Megan; Sanses, Tatiana; Murphy, Miles; Rogers, Rebecca G.

In: Female Pelvic Medicine and Reconstructive Surgery, Vol. 16, No. 6, 2010, p. 340-344.

Research output: Contribution to journalArticle

Molden, S, Bracken, J, Nguyen, A, Harvie, HS, White, A, Hammil, SL, Patterson, D, Tarr, M, Sanses, T, Murphy, M & Rogers, RG 2010, 'A retrospective multicenter study on outcomes after midurethral polypropylene sling revision for voiding dysfunction', Female Pelvic Medicine and Reconstructive Surgery, vol. 16, no. 6, pp. 340-344. https://doi.org/10.1097/SPV.0b013e3181f5ac07
Molden, Stephanie ; Bracken, Jessica ; Nguyen, Aimee ; Harvie, Heidi S. ; White, Amanda ; Hammil, Sarah L. ; Patterson, Danielle ; Tarr, Megan ; Sanses, Tatiana ; Murphy, Miles ; Rogers, Rebecca G. / A retrospective multicenter study on outcomes after midurethral polypropylene sling revision for voiding dysfunction. In: Female Pelvic Medicine and Reconstructive Surgery. 2010 ; Vol. 16, No. 6. pp. 340-344.
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abstract = "Objectives: The purpose of this study was to determine outcomes of sling revision after midurethral sling (MUS) placement and whether timing of sling revision affected those outcomes. Materials and Methods: This is a multicenter study including patients who underwent MUS placement and subsequent sling revision secondary to voiding dysfunction. Diagnostic outcomes before and after sling revision were compared for all sling revision patients with complete data. Logistic regression analyses were performed to determine if revision timing predicted voiding dysfunction and stress incontinence. Results: One hundred seventy-five patients who met the study criteria had complete data. Overall, 70{\%} (133) of MUS were retropubic and 30{\%} (56) were obturator slings. Midurethral sling revision was accomplished by cutting (54{\%}), excision (29{\%}), and pulling down on the mesh (18{\%}). Stress urinary incontinence (SUI) resolved in 38{\%}, urinary tract infections (UTIs) in 69{\%}, and overactive bladder (OAB) in 75{\%}. In comparison, 21{\%} experienced de novo SUI; 18{\%}, de novo UTIs; and 12{\%}, de novo OAB symptoms after revision. Voiding dysfunction resolved in 80{\%}, however 10{\%} experienced new voiding dysfunction symptoms. Retropubic slings displayed more voiding dysfunction, higher de novo/worsened OAB, and more UTIs after revision than obturator slings. Sling revision timing did not predict persistent voiding dysfunction but did predict SUI with earlier revision (≤2 weeks) resulting in less postrevision SUI when compared to revisions at 15-90 days or greater than 90 days. The method of sling revision (cut, excised, pulled down) did not predict SUI, OAB, or obstructive voiding symptoms. Conclusions: Sling revision resolves voiding dysfunction symptoms, UTIs and post-sling OAB symptoms in the majority of patients. Resolution of voiding dysfunction is independent of method and timing of revision; however earlier revision is associated with decreased postrevision SUI.",
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AU - Nguyen, Aimee

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AU - White, Amanda

AU - Hammil, Sarah L.

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AU - Tarr, Megan

AU - Sanses, Tatiana

AU - Murphy, Miles

AU - Rogers, Rebecca G.

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AB - Objectives: The purpose of this study was to determine outcomes of sling revision after midurethral sling (MUS) placement and whether timing of sling revision affected those outcomes. Materials and Methods: This is a multicenter study including patients who underwent MUS placement and subsequent sling revision secondary to voiding dysfunction. Diagnostic outcomes before and after sling revision were compared for all sling revision patients with complete data. Logistic regression analyses were performed to determine if revision timing predicted voiding dysfunction and stress incontinence. Results: One hundred seventy-five patients who met the study criteria had complete data. Overall, 70% (133) of MUS were retropubic and 30% (56) were obturator slings. Midurethral sling revision was accomplished by cutting (54%), excision (29%), and pulling down on the mesh (18%). Stress urinary incontinence (SUI) resolved in 38%, urinary tract infections (UTIs) in 69%, and overactive bladder (OAB) in 75%. In comparison, 21% experienced de novo SUI; 18%, de novo UTIs; and 12%, de novo OAB symptoms after revision. Voiding dysfunction resolved in 80%, however 10% experienced new voiding dysfunction symptoms. Retropubic slings displayed more voiding dysfunction, higher de novo/worsened OAB, and more UTIs after revision than obturator slings. Sling revision timing did not predict persistent voiding dysfunction but did predict SUI with earlier revision (≤2 weeks) resulting in less postrevision SUI when compared to revisions at 15-90 days or greater than 90 days. The method of sling revision (cut, excised, pulled down) did not predict SUI, OAB, or obstructive voiding symptoms. Conclusions: Sling revision resolves voiding dysfunction symptoms, UTIs and post-sling OAB symptoms in the majority of patients. Resolution of voiding dysfunction is independent of method and timing of revision; however earlier revision is associated with decreased postrevision SUI.

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