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      Update on complications of synthetic suburethral slings

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          ABSTRACT

          Synthetic suburethral slings have become the most widely used technique for the surgical treatment of stress urinary incontinence. Despite its high success rates, significant complications have been reported including bleeding, urethral or bladder injury, urethral or bladder mesh erosion, intestinal perforation, vaginal extrusion of mesh, urinary tract infection, pain, urinary urgency and bladder outlet obstruction. Recent warnings from important regulatory agencies worldwide concerning safety issues of the use of mesh for urogynecological reconstruction have had a strong impact on patients as well as surgeons and manufacturers. In this paper, we reviewed the literature regarding surgical morbidity associated with synthetic suburethral slings.

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          [Transobturator urethral suspension: mini-invasive procedure in the treatment of stress urinary incontinence in women].

          E. Delorme (2001)
          Transobturator tape is an artificial tape designed for urethral suspension to treat female stress urinary incontinence. This tape has two original features: its non-woven polypropylene structure is coated with silicone on the urethral surface in order to limit retraction of polypropylene and to establish a barrier to extension of periurethral fibrosis. transmuscular insertion, through the obturator and puborectalis muscles, reproduces the natural suspension fascia of the urethra while preserving the retropubic space. A preliminary study (40 implantations) confirmed the feasibility of this operation, the low morbidity (one complication: sepsis) and the encouraging results between 3 and 12 months; in the treatment of isolated incontinence (16 patients), no postoperative dysuria has been observed; 15 patients are totally continent and 1 patient is improved; in the treatment of prolapse associated with frank or potential incontinence (24 patients), transient postoperative dysuria was observed in 4 cases, with no postoperative incontinence.
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            Retropubic versus transobturator midurethral slings for stress incontinence.

            Holly Richter, Michael Albo, Halina M. Zyczynski … (2010)
            Midurethral slings are increasingly used for the treatment of stress incontinence, but there are limited data comparing types of slings and associated complications. We performed a multicenter, randomized equivalence trial comparing outcomes with retropubic and transobturator midurethral slings in women with stress incontinence. The primary outcome was treatment success at 12 months according to both objective criteria (a negative stress test, a negative pad test, and no retreatment) and subjective criteria (self-reported absence of symptoms, no leakage episodes recorded, and no retreatment). The predetermined equivalence margin was +/-12 percentage points. A total of 597 women were randomly assigned to a study group; 565 (94.6%) completed the 12-month assessment. The rates of objectively assessed treatment success were 80.8% in the retropubic-sling group and 77.7% in the transobturator-sling group (3.0 percentage-point difference; 95% confidence interval [CI], -3.6 to 9.6). The rates of subjectively assessed success were 62.2% and 55.8%, respectively (6.4 percentage-point difference; 95% CI, -1.6 to 14.3). The rates of voiding dysfunction requiring surgery were 2.7% in those who received retropubic slings and 0% in those who received transobturator slings (P=0.004), and the respective rates of neurologic symptoms were 4.0% and 9.4% (P=0.01). There were no significant differences between groups in postoperative urge incontinence, satisfaction with the results of the procedure, or quality of life. The 12-month rates of objectively assessed success of treatment for stress incontinence with the retropubic and transobturator approaches met the prespecified criteria for equivalence; the rates of subjectively assessed success were similar between groups but did not meet the criteria for equivalence. Differences in the complications associated with the two procedures should be discussed with patients who are considering surgical treatment for incontinence. (ClinicalTrials.gov number, NCT00325039.) 2010 Massachusetts Medical Society
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              Urinary incontinence in women.

              Linda Brubaker, Peggy Norton (2006)
              Urinary incontinence is common in women, but is under-reported and under-treated. Urine storage and emptying is a complex coordination between the bladder and urethra, and disturbances in the system due to childbirth, aging, or other medical conditions can lead to urinary incontinence. The two main types of incontinence in women, stress urinary incontinence and urge urinary incontinence, can be evaluated by history and simple clinical assessment available to most primary care physicians. There is a wide range of therapeutic options, but the recent proliferation of new drug treatments and surgical devices for urinary incontinence have had mixed results; direct-to-consumer advertising has increased public awareness of the problem of urinary incontinence, but many new products are being introduced without long-term assessment of their safety and efficacy.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Int Braz J Urol
                Journal ID (iso-abbrev): Int Braz J Urol
                Journal ID (publisher-id): ibju
                Title: International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology
                Publisher: Sociedade Brasileira de Urologia
                ISSN (Print): 1677-5538
                ISSN (Electronic): 1677-6119
                Publication date (Print and electronic): Sep-Oct 2017
                Publication date (Print): Sep-Oct 2017
                Volume: 43
                Issue: 5
                Pages: 822-834
                Affiliations
                [1 ]Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
                Author notes
                Correspondence address: Cristiano Mendes Gomes, MD, Divisão de Clinica Urológica, Hospital das Clinicas da Faculdade de Medicina USP, Avenida Dr. Enéas de Carvalho Aguiar, 255 – 710F, São Paulo, SP, 05403-000, Brasil, Fax: +55 113064-7013 E-mail: crismgomes@ 123456uol.com.br

                CONFLICT OF INTEREST

                None declared.

                Article
                Publisher ID: S1677-5538.IBJU.2016.0250
                DOI: 10.1590/S1677-5538.IBJU.2016.0250
                PMC ID: 5678512
                PubMed ID: 28266818
                SO-VID: 7ba3bf7a-672f-42a0-ab20-2dfaf4d08c66
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 28 April 2016
                Date accepted : 05 December 2016
                Page count
                Figures: 12, Tables: 1, Equations: 0, References: 106, Pages: 13
                Categories
                Subject: Review Article

                Keywords: urinary incontinence,polypropylenes,postoperative complications
                Data availability:
                Keywords: urinary incontinence, polypropylenes, postoperative complications

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