Abstract: PD26-09
Sources of Funding: None

Introduction

There is a debate on the need for complete or partial removal of midurethral slings (MUS) in women presenting with pain only after sling placement. We reviewed our staged approach to determine the rates of success after each procedure.

Methods

Following IRB approval, a prospectively maintained database of women requiring suburethral sling removal (SSR) for pain only between 2005 and 2015 was queried. Data reviewed by a third party investigator not involved in patient care from an electronic medical record included: demographics, type of MUS, onset and location of pain, evaluation (including imaging), surgical findings, and short and long term outcomes, including additional procedures for additional mesh sling arm removal (retropubically for TVT/SPARC and groin dissection for TOT). Pain was ranked by self-report as no pain, improved, same or worse. SSR was performed vaginally with the goal of excising just the suburethral portion of the MUS.

Results

Of 47 patients, 21 (44.6%) were rendered pain-free after SSR alone (Table 1. Flow chart). Among those with residual pain (26), 12 elected conservative management while 7 opted for a secondary retropubic arms removal and another 7 for a secondary translabial obturator arm dissection. None were found to have infected slings. Among the 14 who underwent a secondary procedure for residual pain after SSR, 5 (36%) were rendered pain-free, 3 (21%) improved, 5 (36%) reported the same amount of pain and 1 (7%) had worse pain..After this secondary procedure, 6 women opted for PMR management. Ultimately, despite staged approach and PMR management, 1 (7%) remained with invalidating pain.

Conclusions

Nearly half of women operated for pain only after MUS placement find durable relief after an SSR procedure alone, whereas another 30% elected additional removal of residual mesh arms either suprapubically or in the obturator area.

Funding

None