title: Urethral erosion after synthetic and nonsynthetic pubovaginal slings: differences in management and continence outcome.
abstract: OBJECTIVE
  We present a series of urethral erosion following a pubovaginal sling procedure due to synthetic and nonsynthetic materials and discuss their management and continence outcome.
  
  
  METHODS
  During a 3-year period 57 patients underwent urethrolysis for urethral obstruction after receiving a pubovaginal sling. Urethral erosion, defined as sling material entering the urethral lumen, was present in 9 patients and this cohort comprises the focus of our review. In 3 patients the eroded material was synthetic, that is ProteGen (Boston Scientific, Natick, Massachusetts) in 2 and polypropylene in 1. This condition was treated with removal of the whole sling, multilayer closure of the erosion and selective use of a Martius flap. In 6 patients the eroded material was nonsynthetic, that is allograft fascia in 5 and autograft fascia in 1. This condition was treated with sling incision and multilayer closure of the urethra. Preoperative assessment included a urogynecologic questionnaire, measurement of pad use, a voiding diary, cystourethroscopy and videourodynamics. Postoperatively similar parameters were used to assess continence outcomes and the need for subsequent procedures.
  
  
  RESULTS
  Nine patients were followed 30 months after urethrolysis. All 9 women had some manifestation of voiding dysfunction following the pubovaginal sling procedure, including urinary retention in 4, urge incontinence in 3 and mixed incontinence in 2. Urinary retention resolved in 3 patients and urge incontinence resolved in 4. Stress urinary incontinence (SUI) persisted in 2 of the 3 patients in the synthetic group, while no patient in the nonsynthetic group had recurrent SUI. There were no recurrent urethral erosions or fistulas in either group.
  
  
  CONCLUSIONS
  Urethral erosion after a pubovaginal sling procedure can occur irrespective of the sling material. However, recurrent SUI is not an invariable outcome of the management of urethral erosion following the pubovaginal sling procedure.
authors.affiliation: Division of Urology, Duke University Medical Center, Durham, NC, USA.
authors.forename: Cindy L
authors.initials: CL
authors.lastname: Amundsen
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Flynn
authors.forename: George D
authors.initials: GD
authors.lastname: Webster
mesh_terms: D005206:Fascia Lata / Q000637:transplantation*; D005260:Female; D006801:Humans; D019736:Prostheses and Implants / Q000009:adverse effects*; D013526:Surgical Mesh; D014524:Urethral Obstruction / Q000209:etiology; D014549:Urinary Incontinence / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000009:adverse effects*