title: Functional outcomes for surgical revision of synthetic slings performed for voiding dysfunction: a retrospective study.
abstract: OBJECTIVE
  To determine the functional outcomes after synthetic sling revision surgery performed for voiding dysfunction.
  
  
  METHODS
  A retrospective review of 63 women who underwent surgical revision of a synthetic sling (SS) over an 11 year period between 2000 and 2010 inclusive, for the treatment of voiding dysfunction. Voiding dysfunction was defined as a persistently raised post-void residual of >150 ml. Patient review included demographics, a comprehensive medical history, all surgical reports and a detailed proforma with details of lower urinary tract symptoms, physical findings and bladder diaries. Variables were compared between methods of sling revision using the Fisher exact test (Freeman-Halton extension) with a 2 by 3 contingency table. Statistical significance is defined as P ≤ 0.05.
  
  
  RESULTS
  Sixty-three women underwent SS revision for voiding dysfunction with an overall success rate of 87%. Three types of surgical revision were performed; simple SS division (46/63, 73%), partial excision of SS material (13/63, 21%) and either division or excision but with a concomitant procedure to prevent recurrent SUI (4/63, 6%). Persistent voiding dysfunction following revision in each of the three groups was 5/46 (10.9%), 1/13 (7.7%) and 2/4 (50%) respectively (P=0.09). Subsequent surgery for recurrent SUI in each of the groups was 1/46 (2.2%), 3/13 (23.1%) and 0/4 (0%) respectively (P=0.04).
  
  
  CONCLUSIONS
  Surgical revision of a SS is an effective treatment for postoperative voiding dysfunction. Both simple division and partial excision of the SS are successful, but simple division carries a lower risk of recurrent SUI. A concomitant SUI procedure at the time of revision may prevent recurrence but may increase the risk of persistent voiding dysfunction.
authors.affiliation: Department of Urogynaecology, Mercy Hospital for Women, Victoria, Australia. gerryagnew@gmail.com
authors.forename: Gerard
authors.initials: G
authors.lastname: Agnew
authors.forename: Peter L
authors.initials: PL
authors.lastname: Dwyer
authors.forename: Anna
authors.initials: A
authors.lastname: Rosamilia
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Edwards
authors.forename: Joseph K
authors.initials: JK
authors.lastname: Lee
mesh_terms: D000328:Adult; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects; D006801:Humans; D011183:Postoperative Complications / Q000601:surgery; D019736:Prostheses and Implants; D012086:Reoperation; D012189:Retrospective Studies; D053825:Suburethral Slings / Q000009:adverse effects*; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D014555:Urination Disorders / Q000601:surgery*