[Urinary complications in sub-urethral sling procedures].
BACKGROUND
Urinary complications following sub urethral sling procedures are common, and management of these complications continue to be discussed.


METHODS
The literature available on Medline/PubMed, relating to urinary complications associated with suburethral sling procedures, was reviewed.


RESULTS
Bladder perforation, which occurs with an incidence of 5.7% in tension-free vaginal tape procedure, requires repositioning of the sling, but does not cause any increase in postoperative morbidity. The trans-obturator approach appears to decrease this risk. Urethral perforation, which is uncommon (0.4-1%), is a contraindication to maintenance of the sling. Bladder erosion is rare, requiring resection of the mesh with a combined abdominal and cystoscopic approach. Urethral mesh erosion (0.07% to 1.5%) also requires surgical sling removal, but few patients remain continent because this removal requires a large urethrolysis (recurrence rate of incontinence is 66% following removal of the sling). Bladder outlet obstruction occurs frequently after sub-urethral procedures. When complete obstruction is clinically evident 2 days after a sub-urethral sling procedure, immediate reintervention is performed with a rapid return to normal voiding. Recurrence rate of stress incontinence is less than 30% following reintervention.
Deffieux
X
X
Service de Gynécologie-Obstétrique, Hôpital Antoine-Béclère, Clamart. x.deffieux@free.fr
Bonnet
K
K
Chevalier
N
N
Gervaise
A
A
Frydman
R
R
Fernandez
H
H
D004868:Equipment Failure; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology; D016239:MEDLINE; D011183:Postoperative Complications / Q000453:epidemiology; D012008:Recurrence; D013526:Surgical Mesh; D014521:Urethra; D001743:Urinary Bladder / Q000293:injuries; D001745:Urinary Bladder Diseases / Q000453:epidemiology / Q000209:etiology; D001748:Urinary Bladder Neck Obstruction / Q000453:epidemiology / Q000209:etiology; D014549:Urinary Incontinence / Q000601:surgery*; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000209:etiology; D014570:Urologic Diseases / Q000453:epidemiology* / Q000209:etiology; D013520:Urologic Surgical Procedures / Q000009:adverse effects* / Q000379:methods