Abstract: PD50-11
Sources of Funding: None

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%.

Funding

None