title: Voiding dysfunction following removal of eroded synthetic mid urethral slings.
abstract: OBJECTIVE
  Voiding dysfunction following genitourinary erosion of synthetic mid urethral slings is not clearly reported. We investigated the incidence of voiding dysfunction in patients following sling excision due to vaginal, urethral or intravesical mesh erosion.
  
  
  METHODS
  Retrospective review identified 19 patients with genitourinary erosion of polypropylene mesh slings. Comprehensive urological evaluation was performed in all patients, and perioperative and postoperative data were analyzed. Voiding dysfunction was defined as refractory storage symptoms, emptying symptoms and pelvic pain. All subsequent medical and surgical interventions were recorded.
  
  
  RESULTS
  In 19 patients a total of 11 vaginal, 7 intravesical and 5 urethral erosions occurred. Mean patient age was 52 years (range 32 to 69) and average followup was 8.4 months (range 3 to 34). Average time from symptom onset to sling removal was 10.1 months (range 1.5 to 38). Of the 19 patients 14 (74%) presented with multiple symptoms. Symptoms varied, including refractory pain, recurrent infections and bladder storage/emptying dysfunction. Urodynamic studies were abnormal preoperatively and postoperatively in 9 of 13 (69%) and 4 of 6 patients (67%), respectively. Following surgery lower urinary tract symptoms resolved completely in only 4 of the 19 patients (21%). Stress incontinence recurred in 8 of the 19 patients (42%). Five patients underwent simultaneous pubovaginal sling, of whom none had recurrent stress urinary incontinence. Only 9 patients (47%) considered themselves dry with no pads following surgery. Four patients required further surgery for refractory voiding symptoms.
  
  
  CONCLUSIONS
  Voiding dysfunction is not an uncommon finding after sling excision in the setting of genitourinary erosion. It may cause additional patient morbidity.
authors.affiliation: Department of Urologic Surgery, Vanderbilt University Medical Center, A-1302 Medical Center North, Nashville, TN 37232, USA.
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Starkman
authors.forename: Christopher
authors.initials: C
authors.lastname: Wolter
authors.forename: Alex
authors.initials: A
authors.lastname: Gomelsky
authors.forename: Harriette M
authors.initials: HM
authors.lastname: Scarpero
authors.forename: Roger R
authors.initials: RR
authors.lastname: Dmochowski
mesh_terms: D000328:Adult; D000368:Aged; D020878:Device Removal / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D011475:Prosthesis Failure; D013526:Surgical Mesh; D014550:Urinary Incontinence, Stress / Q000601:surgery; D014555:Urination Disorders / Q000453:epidemiology / Q000209:etiology*