Abstract: PD50-06
Sources of Funding: None

Introduction

Since the widespread adoption of the synthetic mesh mid-urethral sling (MUS) for the treatment of stress urinary incontinence (SUI), proper placement of the sling at the mid urethra has been emphasized. There is limited and conflicting evidence on the importance of the mid-urethral position with regards to continence outcomes, however. We aimed to describe our experience of sling position in women presenting for MUS excision.

Methods

We retrospectively reviewed our database of patients who underwent translabial ultrasound (TLUS) prior to MUS excision for mesh-related complications between January 2013 and May 2014 at UCLA. Patients were excluded if they had a history of pelvic radiation, neurogenic voiding dysfunction, transvaginal mesh placement for prolapse, urethral erosion, multiple slings, prior revision of an anti-SUI surgery, post-void residual > 150 cc, or did not undergo preoperative urodynamics (UDS). Patients were stratified into 2 cohorts based on absence or presence of SUI on UDS. Sling position was categorized as proximal urethra or bladder neck, mid urethra, or distal urethra based on sagittal images of the TLUS. Sling position was assessed by a radiologist. For cases in which the sling position overlapped between more than one location, the dominant location was determined by a FPMRS fellow (JO).

Results

96 patients were identified. Median age was 56.4 years old (range 32-83). Median time from last mesh placement to MUS excision was 4.76 years (1.4-13.6). Among 19 patients without SUI on UDS, the sling was located in the distal, mid, and proximal urethra in 19 (24.7%), 43 (55.8%), and 15 (19.5%) patients, respectively. Among 77 patients with SUI on UDS, the sling was located in the distal, mid, and proximal urethra in 4 (21.1%), 13 (68.4%), and 2 (10.5%) patients, respectively. Comparing the distribution of slings located at the mid urethra versus outside of the mid urethra, there was no significant difference between the cohorts (p=0.4). There were also no significant differences in age, prior vaginal deliveries, or time to MUS excision. Patients presenting with SUI had a significantly higher body mass index (p=0.02), however.

Conclusions

Many patients who have a successful outcome following MUS as defined as resolution of SUI have a sling located outside of the mid urethra. Thus, mid-urethral position may not be as critical to achieving continence with a MUS as previously thought. We hypothesize that it is the ability of a MUS to provide a &[Prime]hammock&[Prime] of support, regardless of position, that contributes to successful continence outcomes.

Funding

None