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Lau HH, Davila GW, Chen YY, Sartori MGF, Jármy-Di Bella ZIK, Tsai JM, Liu YM, Su TH. FIGO recommendations: Use of midurethral slings for the treatment of stress urinary incontinence. Int J Gynaecol Obstet 2023; 161:367-385. [PMID: 36786495 DOI: 10.1002/ijgo.14683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 01/02/2023] [Accepted: 01/03/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND Stress urinary incontinence (SUI) is a global problem. It can significantly adversely impact a woman's quality of life. The use of synthetic mesh in vaginal surgery is controversial, especially when used for pelvic organ prolapse surgery. Although negative effects have been reported, the synthetic mesh midurethral sling (MUS) is considered to be safe and effective in the surgical treatment of SUI. OBJECTIVES To provide evidence-based data and recommendations for the obstetrician/gynecologist who treats women with SUI and performs or plans to perform MUS procedures. METHODS Academic searches of MEDLINE, the Cochrane Library, Embase, and Google Scholar articles published between 1987 and March 2020 were performed by a subgroup of the Urogynecology and Pelvic Floor Committee, International Federation of Gynecology and Obstetrics (FIGO). SELECTION CRITERIA The obtained scientific data were associated with a level of evidence according to the Oxford University Centre for Evidence-Based Medicine and GRADE Working Group system. In the absence of concrete scientific evidence, the recommendations were made via professional consensus. RESULTS The FIGO Urogynecology and Pelvic Floor Committee reviewed the literature and prepared this evidence-based recommendations document for the use of MUS for women with SUI. CONCLUSIONS Despite the extensive literature, there is a lack of consensus in the optimal surgical treatment of SUI. These recommendations provide a direction for surgeons to make appropriate decisions regarding management of SUI. The MUS is considered safe and effective in the treatment of SUI, based on many high-quality scientific publications and professional society recommendations. Comprehensive long-term data and systemic reviews are still needed, and these data will become increasingly important as women live longer. These recommendations will be continuously updated through future literature reviews.
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Affiliation(s)
- Hui-Hsuan Lau
- MacKay Medical College, New Taipei City, Taiwan.,Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan.,Department of Obstetrics and Gynecology, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan.,MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
| | - G Willy Davila
- Center for Urogynecology and Pelvic Health, Holy Cross Medical Group, Fort Lauderdale, Florida, USA
| | - Ying-Yu Chen
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan.,Department of Obstetrics and Gynecology, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
| | - Marair G F Sartori
- Department of Gynecology, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | - Jung-Mei Tsai
- MacKay Medical College, New Taipei City, Taiwan.,College of Nursing and Health Sciences, Dayeh University, Changhua, Taiwan.,Department of Nursing, MacKay Memorial Hospital, Taipei, Taiwan
| | - Yu-Min Liu
- Department of Medical Research, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan.,Division of Cardiology, Department of Medicine, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
| | - Tsung-Hsien Su
- MacKay Medical College, New Taipei City, Taiwan.,Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan.,Department of Obstetrics and Gynecology, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan.,Department of Nursing, MacKay Memorial Hospital, Taipei, Taiwan
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Islam MM, Islam MS, Alam AK, Hallaz MM. Complications of the suburethral sling in the form of Mini Vaginal Tape (MVT): A case report. Int J Surg Case Rep 2022; 93:106946. [PMID: 35318186 PMCID: PMC8935493 DOI: 10.1016/j.ijscr.2022.106946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 03/12/2022] [Accepted: 03/13/2022] [Indexed: 11/08/2022] Open
Abstract
Synthetic sub-urethral sling has become the most widely used technique for the surgical management of stress urinary incontinence. Despite a higher success rate, complications like migration, encrustation, and stone formation have been reported by a mid-urethral sling (MUS). Among mid-urethral sling procedures, mini vaginal tape (MVT) is very popular. As periurethral stone formation and urethrovaginal fistula are very uncommon after MVT, case report on this issue is sparse. The current case report features a 55-year female presented with lower abdominal pain and continuous urinary incontinence, 10 years after the MVT. She was diagnosed as a case of periurethral stone with urinary incontinence due to urethro-vaginal fistula. Our surgical team successfully removed the stone formed by the encrustation of the displaced tape and repaired the fistula. Following the MVT, a high degree of suspicion and long-term follow-up is mandatory for the diagnosis and management of these rare complications. Mini vaginal tape (MVT), a form of synthetic mid-urethral sling is popular for treating stress urinary incontinence. There are limited reports on periurethral stone formation and urethrovaginal fistula by MVT as it is rare. This study presents a case of periurethral stone in the MVT with urinary incontinence due to urethrovaginal fistula. Although rare, a high degree of suspicion is mandatory for the diagnosis and management of these rare complications.
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Neu S, Locke J, Goldenberg M, Herschorn S. Urethrovaginal fistula repair with or without concurrent fascial sling placement: A retrospective review. Can Urol Assoc J 2020; 15:E276-E280. [PMID: 33119501 DOI: 10.5489/cuaj.6786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We sought to review outcomes of urethrovaginal fistula (UVF) repair, with or without concurrent fascial sling placement. METHODS All patients diagnosed with UVF at our center from 1988-2017 were included in this study. Patient charts were reviewed from a prospectively kept fistula database, and patient characteristics and surgical outcomes were described. Descriptive statistics were applied to compare complication rates between patients with or without fascial sling placement at the time of UVF repair. RESULTS A total of 41 cases of UVF were identified, all of which underwent surgical repair. Median age at diagnosis was 49 years (interquartile range [IQR] 35-62). All patients had undergone pelvic surgery. UVF etiology was secondary to stress urinary incontinence (SUI) surgery in 17 patients (41%) and urethral diverticulum repair in seven patients (17%). The most common presenting symptom was continuous incontinence in 19 patients (46%). Nineteen patients had a fascial sling placed at the time of surgery (46%), with no significant difference in complication rates (26% vs. 23%, p=0.79). Two patients had Clavien-Dindo grade I complications (5%) and one had a grade III complication (2%). Four patients had long-term complications (10%), including urinary retention, chronic pain, and urethral stricture. Two patients had UVF recurrence (5%). Median followup after surgery was 21 months (IQR 4-72). CONCLUSIONS UVF should be suspected in patients with continuous incontinence following a surgical procedure. Most UVF surgical repairs are successful and can be done with concurrent placement of a fascial sling.
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Affiliation(s)
- Sarah Neu
- Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Jennifer Locke
- Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | | | - Sender Herschorn
- Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
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Schöller D, Brucker S, Reisenauer C. Management of Urethral Lesions and Urethrovaginal Fistula Formation Following Placement of a Tension-Free Suburethral Sling: Evaluation From a University Continence and Pelvic Floor Centre. Geburtshilfe Frauenheilkd 2018; 78:991-998. [PMID: 30364366 PMCID: PMC6195430 DOI: 10.1055/a-0704-3461] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 08/18/2018] [Accepted: 08/19/2018] [Indexed: 11/21/2022] Open
Abstract
Introduction
The complication of tape erosion in the urethra following placement of a retropubic (TVT) or transobturator (TOT) tension-free suburethral vaginal sling or an accidental iatrogenic transurethral tape position can result in the formation of a urethrovaginal or vesicovaginal fistula. The objective of the investigation is the evaluation of the management of such rare complications.
Patients and Methods
Retrospective analysis of 14 patients who were treated for a urethral lesion or urethrovaginal fistula formation status post TVT/TOT placement between June 2011 and February 2018 in the Tübingen University Department of Gynaecology.
Results
As surgical therapy, 57.1% (n = 8) cases underwent vaginal fistula closure using a Martius flap of the labium majus and in 21.4% (n = 3) using a vaginal rotation skin flap. In 21.4% (n = 3), exclusively vaginal suture reconstruction of the urethra following excision of the tape running transurethrally or tape erosion was performed. 50% (n = 7) of the patients had lasting continence postoperatively without any further need for therapy. In 28.6% (n = 4), there was ongoing stress urinary incontinence, in 21.4% (n = 3) mixed urinary incontinence. Six of the 7 patients with persistent incontinence underwent new placement of a tension-free suburethral retropubic sling (TVT) an average of 8.8 months (5 – 13 months) postoperatively which was uncomplicated in all patients and achieved satisfactory continence. The 3 patients with mixed urinary incontinence and persistent urgency components additionally received anticholinergic medication. During the time period investigated, there were no long-term complications, in particular no recurrent fistulas.
Conclusion
The rare but relevant complications of a urethral erosion, transurethral tape position or urethrovaginal fistula formation status post TVT/TOT placement can be successfully managed via vaginal surgery. Persistent postoperative urinary incontinence with the need for a two-phase repeat TVT placement following sufficient wound healing must be preoperatively clarified.
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Affiliation(s)
- Dorit Schöller
- Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
| | - Sara Brucker
- Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
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