Simple sling incision for the treatment of iatrogenic urethral obstruction.
OBJECTIVE
To review a single-institution experience with sling incision to treat urethral obstruction resulting from pubovaginal sling placement. Urethrolysis involving full mobilization of the urethra has traditionally been used to treat urethral obstruction resulting from a pubovaginal sling. Recently, sling incision has been reported to be a technically simpler, less potentially morbid technique to relieve such obstruction.


METHODS
The charts of 14 women with iatrogenic urethral obstruction from pubovaginal slings who were treated with simple sling incision were reviewed. Presenting symptoms and physical findings and outcomes (primarily resolution of obstructive and irritative symptoms, change in postvoid residual volume, and change in continence status) were evaluated.


RESULTS
Eleven patients had a biologic sling and three a mid-urethral polypropylene mesh sling. All patients had either obstructive or irritative findings or retention and 10 of 14 had an elevated postvoid residual volume. The average follow-up was 12 months. Overall, 13 (93%) of 14 had complete or significant improvement of presenting complaints, and 1 (7%) eventually required formal urethrolysis. Of the 13 with resolution of presenting complaints, 3 had residual irritative symptoms. Although 3 (21%) of 14 had some element of recurrent stress urinary incontinence, only 1 (7%) required treatment.


CONCLUSIONS
Simple sling incision is an effective, technically simple, and safe treatment for women with iatrogenic urethral obstruction after placement of a pubovaginal sling. Its results are comparable to those of formal urethrolysis, and it may be considered as first-line treatment for iatrogenic obstruction after a sling procedure.
Goldman
Howard B
HB
Department of Urology, Case Western Reserve University School of Medicine, University Hospitals of Cleveland, Cleveland, Ohio 44106-5046, USA.
D004868:Equipment Failure; D005205:Fascia; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007049:Iatrogenic Disease; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery*; D019736:Prostheses and Implants; D012008:Recurrence; D012189:Retrospective Studies; D013526:Surgical Mesh; D014524:Urethral Obstruction / Q000209:etiology / Q000601:surgery*; D014549:Urinary Incontinence / Q000601:surgery*; D016055:Urinary Retention / Q000209:etiology / Q000601:surgery