title: Disabling complications with slings for managing female stress urinary incontinence.
abstract: OBJECTIVE
  To report an increase in the referral of patients with disabling complications after the failure of conservative therapy, their presentation, final surgical management and clinical outcome, following the use of non-autologous slings (NAS), currently the primary surgical procedure for managing stress urinary incontinence (SUI) in women.
  
  
  METHODS
  Thirty-eight patients (mean age 64 years) required surgical management for disabling complications after placing a NAS for SUI. Sling types were synthetic (25), xenografts (six) and allografts (four). Twenty (53%) patients presented with bladder outlet obstruction, 13 (34%) with sling erosion, three (8%) with worsened SUI, and two (5%) with unobstructive severe urgency and frequency.
  
  
  RESULTS
  The sling was dissected and incised with no complication in 19 of 20 patients. One had a posterior urethral defect during sling dissection. Twelve patients (60%) acquired normal voiding and were continent. Among the 13 patients who had the sling dismantled and urethrolysis, two had recurrent or persistent SUI, two de-novo urgency/frequency and one developed osteitis pubis. Three patients with disabling SUI received a pubovaginal sling placed proximal to the bladder neck, and had an overall improvement in their urinary control with no retention. Two unobstructed patients with urgency and frequency did not improve with anticholinergic medication and pelvic floor therapy, and are now candidates for botulinum toxin injection or neurostimulation.
  
  
  CONCLUSIONS
  The complication rate with periurethral NAS for managing SUI in females is substantial. Patients with refractory urgency/frequency after the sling need a complete evaluation with cystoscopy and video-urodynamics. Obstruction and erosion are the commonest problems and require surgical correction.
authors.affiliation: Division of Urology, University of South Florida, Tampa, FL 33612-9497, USA.
authors.forename: Raul
authors.initials: R
authors.lastname: Ordorica
authors.forename: Alejandro R
authors.initials: AR
authors.lastname: Rodriguez
authors.forename: Fernando
authors.initials: F
authors.lastname: Coste-Delvecchio
authors.forename: Mitchell
authors.initials: M
authors.lastname: Hoffman
authors.forename: Jorge
authors.initials: J
authors.lastname: Lockhart
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003558:Cystoscopy / Q000379:methods; D006233:Persons with Disabilities / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery*; D012017:Referral and Consultation / Q000706:statistics & numerical data; D053825:Suburethral Slings / Q000009:adverse effects*; D014524:Urethral Obstruction / Q000209:etiology / Q000601:surgery*; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D014563:Urodynamics / Q000502:physiology*