Podium Session

Poster, Podium & Video Sessions

PD50-11: Management of urinary incontinence following sub-urethral sling removal

Monday, May 15
8:40 AM - 8:50 AM
Location: BCEC: Room 157

Presentation Authors: Nirmish Singla*, Himanshu Aggarwal, Jeannine Foster, Feras Alhalabi, Gary Lemack, Philippe Zimmern, Dallas, TX

Introduction: We sought to evaluate de novo and persistent urinary incontinence outcomes following synthetic sub-urethral sling removal (SSR) in women.

Methods: We reviewed a prospectively maintained database of 360 consecutive women who underwent SSR between 2005 and 2015. We excluded patients who had neurogenic bladder, non-synthetic or multiple slings, prior mesh for prolapse, concomitant surgery at the time of sling excision, urethral erosion or urethrovaginal fistula, post-operative retention, or less than 6 months follow-up. Demographics, type of sling, indications for removal, time to removal, and patient-reported outcomes were recorded. All SSR were performed transvaginally under general anesthesia with removal of as much sling as possible. Post-operative outcomes were stratified by type of incontinence (stress-predominant (SUI), urge-predominant (UUI), and mixed (MUI)). Subsequent management (observation/medications, minimally-invasive intervention (urethral bulking agent, sacral neuromodulation, onabotulinumtoxinA injection), or more invasive surgery (sling, bladder suspension)) was evaluated. Success or "dry" was defined by response of 0 (none) or 1 (rarely) on UDI-6 questions 2 and 3 and self-reported satisfaction with continence at last visit, and no further anti-incontinence intervention.

Results: 99 patients met study criteria. Mean follow-up was 24 months (range 6-114). Mean duration from sling placement to SSR was 58 months (range 5-156). Median age and BMI were 55 years and 25.3 kg/m2, respectively. 78% underwent prior hysterectomy and 64% were post-menopausal. 71% of slings were retropubic. Of 99 women, 27 (27%) denied any subjective leakage following SSR alone, while 72 (73%) experienced some degree of incontinence post-operatively: 26 with SUI (7 persistent, 19 de novo), 14 with UUI (6 persistent, 8 de novo), and 32 with MUI (13 persistent, 19 de novo). However, following a single minimally-invasive intervention, success rates rose to 81% in women with SUI, 86% in those with UUI, and 75% in those with MUI (Table).

Conclusions: Patients undergoing SSR may experience cure (>25%) or de novo or persistent urinary incontinence, with a higher predilection for UUI or MUI. However, after a single minimally-invasive intervention following SSR, success rates reached 75-86%.

Source Of Funding: None

Nirmish Singla, MD

UTSW

Nirmish Singla, MD, is currently a urology resident at the University of Texas Southwestern Medical Center in Dallas, TX (USA). He obtained his Bachelor of Science in Engineering (BSE) degree in Biomedical Engineering from the University of Michigan, followed by his Medical Degree (MD) from the University of Michigan Medical School.

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