title: Management of recurrent stress urinary incontinence and urinary retention following midurethral sling insertion in women.
abstract: BACKGROUND
  Synthetic midurethral slings are the most common operations performed for women with stress urinary incontinence (SUI). However, there is only very scarce evidence regarding the management of complications from these operations. The aim of this survey was to canvass expert  opinion regarding the management of recurrent SUI and urinary retention following insertion of these slings.
  
  
  METHODS
  Expert urologists and urogynaecologists in the UK with an interest in SUI were identified. Three clinical scenarios on recurrent SUI and one on urinary retention following  midurethral sling placements were emailed twice to the experts.
  
  
  RESULTS
  The majority of the experts chose a repeat synthetic midurethral retropubic transvaginal tape (TVT) as the procedure of choice for recurrent SUI in patients who had had a previous TVT or midurethral transobturator  tape inserted. In patients who continued to suffer SUI after a failed second TVT, there were mixed results with experts choosing fascial slings, colposuspension and bulking agents as their preferred method of treatment. In women who develop urinary retention following a TVT, tape pull-down  within two weeks was the preferred method among the experts. However, division of the tape within two to six weeks following the procedure was also popular.
  
  
  CONCLUSIONS
  Based on expert opinion, it is difficult to make a recommendation as to the best method of treating recurrent SUI or  urinary retention following tape insertion. There is an urgent requirement for well conducted, multicentre, randomised clinical trials to look at the management of these complications and also the tools used to assess the patient before salvage surgical management.
authors.affiliation: North Bristol NHS Trust, UK. hashim@bui.ac.uk
authors.forename: H
authors.initials: H
authors.lastname: Hashim
authors.forename: T R
authors.initials: TR
authors.lastname: Terry
mesh_terms: D005260:Female; D019538:Health Care Surveys; D006801:Humans; D019919:Prosthesis Implantation; D012008:Recurrence; D053825:Suburethral Slings; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D016055:Urinary Retention / Q000601:surgery*