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The effects of “cut the unilateral midurethral sling off” in women with voiding dysfunctions after anti-incontinence surgery
IUGA Academy. Ngo Y.
Jun 30, 2018; 213027
Topic: Dysfunctional Voiding
Yeh Giin Ngo
Yeh Giin Ngo

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518

The effects of “cut the unilateral midurethral sling off” in women with voiding dysfunctions after anti-incontinence surgery

Ngo, YG1

1: Chang Gung Memorial Hospital, Chiayi.

Introduction: Midurethral synthetic sling(MUS) is the standard surgical procedure for women with stress urinary incontinence. However, small portion of patients experienced voiding dysfunction after this surgery is debilitating their quality of life too.

Objective: Our study is to demonstrate the effectiveness of cutting unilateral sling off due to postoperative voiding dysfunction, and secondarily, to evaluate the changes of urodynamic parameters.

Methods: This is a retrospective study. We reviewed charts of patients who received “cut the unilateral sling off” due to voiding dysfunctions after anti-incontinence sling procedures. The anti-incontinence procedures include a variety of sorts of MUS. The cut-off procedures were done at the site of 9 or 3 o’clock direction of urethral meatus (Figure 1), patients were treated with an OPD surgery under IVGA. Pre- and post-operative subjective and objective parameters were compared.

Results: We collected 15 patients who underwent cutting unilateral sling off due to voiding dysfunction following anti-incontinence procedures with a variety of MUS. The overall incidence of “cut-off procedure” in subgroups of Advantage, TVT-O, and Solyx were 4.2%, 9.09%, 14.7% respectively Figure 2). Incidence of iatrogenic obstruction required cut-off procedure was 5.70% (15/263). Cut-off procedures were performed at a median interval of 7.1 months (±SD of 10.47 months), mean interval of 10.29 months after sling insertion. The subjective results of Patient Global Impression of Improvement (PGI-I) after cut-off procedures showed overall satisfaction with 93.75%, 14 of 15 patients reported PGI-I scale 1 (very much better) and 2 (much better). Secondarily, after cut-off procedure, median maximum flow rate increased from 14.8ml/sec to 21ml/sec, voided volume decreased from 324.5ml to 248ml, and post void residual volume decreased from 231ml to 40.4ml.

Conclusion: In case of voiding dysfunction following anti-incontinence procedure with MUS, iatrogenic bladder outlet obstruction should not be ignored. “Cut the unilateral midurethral sling off “ is effective in management of voiding dysfunction following anti-incontinence surgery with a low risk of recurrence of urinary incontinence.

Figure 1. “Cut the unilateral sling off” procedures were done at the site of 9 or 3 o’clock direction of urethral meatus.


Figure 2. Overall incidence of “cut-off procedure” among different types of midurethral slings.


References:

  1. The International Urogynecology Journal. 1996;7:81-86.
  2. Int Urogynecol J. 2015;26(6):787-789.
  3. Int Urogynecol J Pelvic Floor Dysfunct. 2008;Aug(19(8)):1043-1047.

Disclosure:

Work supported by industry: no.

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