title: Early vs late midline sling lysis results in greater improvement in lower urinary tract symptoms.
abstract: OBJECTIVE
  Lower urinary tract symptoms (LUTS) occur in 5-20% of women after antiincontinence procedures. Symptoms include complete urinary retention or storage, voiding, and postmicturition symptoms. The goal of this study was to determine the effect of time from sling placement to midline sling lysis on overall improvement in LUTS.
  
  
  METHODS
  After institutional review board approval, we conducted a retrospective cohort analysis of 112 subjects undergoing midline sling lysis from January 1997-September 2007. The inclusion criteria were women with a vaginal midline sling lysis for LUTS after a prior pubovaginal or midurethral sling. We excluded any subject with sling erosion without LUTS and those who underwent a repeated sling at the time of lysis. We compared subjects who had an early sling lysis (< or = 1 year from sling to lysis) to a late sling lysis (> 1 year). The primary outcome was based on the subject's report of overall improvement in symptoms. We abstracted data on demographics, presenting symptoms, physical examination, date of antiincontinence procedure, date of midline sling lysis, and postoperative symptoms. Statistical analysis consisted of Student t test, chi(2) test, Fisher exact test, and multivariate logistic regression.
  
  
  RESULTS
  Of 112 subjects, 74 (66%) had an early sling lysis and 38 (34%) had a late sling lysis. These 2 groups were similar in age, menopausal status, presence of preoperative LUTS, anterior colporrhaphy at the time of lysis, and presence of an eroded sling. The early lysis group had a higher percentage of midurethral slings (36% vs 8%; P = .001), a lower rate of preoperative complete retention (70% vs 89%; P = .001), and a lower rate of prior urethrolysis (16% vs 45%; P = .003). No significant difference in follow-up time was found between early lysis compared with late lysis (49 +/- 89 months vs 43 +/- 71 months; P = .73). Ten (8.9%) subjects developed recurrent stress urinary incontinence after sling lysis, which was independent of time to lysis. In all, 94 (84%) subjects had improvement in their LUTS after midline sling lysis. Overall improvement occurred more often in the early sling lysis group compared with the late sling lysis group (91% vs 71%; P = .01). This finding retained significance in a multivariate logistic regression model, which included age, prior urethrolysis, preoperative complete retention, and type of sling (odds ratio, 4.0; 95% confidence interval, 1.2-13.2).
  
  
  CONCLUSIONS
  Based on this large cohort, patients may benefit from earlier midline sling lysis within 1 year for LUTS after a pubovaginal or midurethral sling procedure. The development of recurrent stress urinary incontinence after midline sling lysis is relatively low.
authors.affiliation: Division of Urogynecology, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, USA.
authors.forename: Mary M T
authors.initials: MM
authors.lastname: South
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Wu
authors.forename: George D
authors.initials: GD
authors.lastname: Webster
authors.forename: Alison C
authors.initials: AC
authors.lastname: Weidner
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Roelands
authors.forename: Cindy L
authors.initials: CL
authors.lastname: Amundsen
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D011183:Postoperative Complications / Q000503:physiopathology*; D020127:Recovery of Function; D012008:Recurrence; D012189:Retrospective Studies; D053825:Suburethral Slings; D014521:Urethra / Q000601:surgery; D014550:Urinary Incontinence, Stress / Q000503:physiopathology* / Q000601:surgery*; D016055:Urinary Retention / Q000503:physiopathology; D013520:Urologic Surgical Procedures / Q000379:methods*; D014621:Vagina / Q000601:surgery