title: Midurethral sling incision: indications and outcomes.
abstract: OBJECTIVE
  Controversy continues over the effectiveness of sling incision, which is the most common operative approach to treating complications following suburethral sling insertion. This retrospective analysis assessed the indications for sling incision and patient outcomes regarding resolution of complications and stress urinary incontinence.
  
  
  METHODS
  A review was conducted of the medical records of women who underwent sling incision between 2003 and 2010. Data such as surgical indications, ultrasound findings and medical outcomes were extracted from 198 records, and descriptive and inferential statistical methods of analysis were used.
  
  
  RESULTS
  In the 198 patients eligible for study inclusion, the primary reasons for sling incision were overactive bladder (68 %), voiding dysfunction (61 %), and recurrent urinary tract infections (53 %). Additional complications included dyspareunia (18 %), chronic pelvic pain (17 %), and sling exposure (15 %). Sling incision led to immediate postoperative cure of voiding dysfunction in 97 % of patients. Cure rates for overactive bladder and dyspareunia were 60 % and 94 % respectively. Chronic pelvic pain was resolved in 82 % of cases and all cases of sling exposure were cured. Eighty-five (61 %) of the 140 patients who were continent before sling incision developed recurrent stress urinary incontinence (SUI) postoperatively.
  
  
  CONCLUSIONS
  These findings indicate that sling incision can be highly successful in improving voiding dysfunction and dyspareunia, and moderately successful in curing overactive bladder and chronic pain. However, SUI may recur in more than 60 % of the patients undergoing sling incision. Consequently, patients being considered for a sling incision procedure should be informed about this possible complication.
authors.affiliation: Department of Gynecology and Obstetrics, Cantonal Hospital Frauenfeld, Postfach, 8501 Frauenfeld, Switzerland. volker.viereck@stgag.ch
authors.forename: Volker
authors.initials: V
authors.lastname: Viereck
authors.forename: Oliver
authors.initials: O
authors.lastname: Rautenberg
authors.forename: Jacek
authors.initials: J
authors.lastname: Kociszewski
authors.forename: Susanne
authors.initials: S
authors.lastname: Grothey
authors.forename: JoEllen
authors.initials: J
authors.lastname: Welter
authors.forename: Jakob
authors.initials: J
authors.lastname: Eberhard
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects*; D006801:Humans; D008875:Middle Aged; D017773:Pelvic Floor / Q000000981:diagnostic imaging; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D053825:Suburethral Slings / Q000009:adverse effects*; D013557:Switzerland / Q000453:epidemiology; D014463:Ultrasonography; D014555:Urination Disorders / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery