title: Salvage surgery after failed treatment of synthetic mesh sling complications.
abstract: OBJECTIVE
  We report our experience with the diagnosis and treatment of refractory synthetic sling complications in women.
  
  
  METHODS
  This is a retrospective study of consecutive women with failed treatments for mesh sling complications. Before and after surgery the patients completed validated questionnaires and voiding diaries, and underwent uroflow with post-void residuals, pad test, cystourethroscopy and videourodynamic studies. Treatment was individualized, and results were subdivided into the 2 groups of conditions and symptoms. Outcomes were assessed with the Patient Global Impression of Improvement with success classified as a score of 1, improvement as 2 to 3 and failure as 4 to 7.
  
  
  RESULTS
  A total of 47 women 35 to 83 years old (mean 60) had undergone at least 1 prior operation (range 1 to 4) to correct sling complications. Original sling composition was type 1 mesh in 36 patients and types 2 and 3 in 11. Surgical procedures included sling incision, sling excision, urethrolysis, urethral reconstruction, ureteroneocystotomy, cystectomy and urinary diversion, and enterocystoplasty. Median followup was 2 years (range 0.25 to 12, mean 3). Overall a successful outcome was achieved in 34 of 47 patients (72%) after the first salvage surgery. Reasons for failure were multiple for each patient. Of the 13 patients with treatment failure 9 subsequently underwent 14 operations. Success/improvement was achieved in 5 women (56%) after continent urinary diversion (1), continent urinary diversion and cystectomy (1), partial cystectomy and augmentation cystoplasty (1), biological sling and sinus tract excision (1), and vaginal mesh excision (1).
  
  
  CONCLUSIONS
  Success after the initial failure of mesh sling complications repair is possible but multiple surgeries may be required. Each symptom should be addressed separately.
authors.affiliation: Weill Medical College of Cornell University and Urocenter of New York, New York, New York.
authors.forename: Jerry G
authors.initials: JG
authors.lastname: Blaivas
authors.forename: Rajveer S
authors.initials: RS
authors.lastname: Purohit
authors.forename: James M
authors.initials: JM
authors.lastname: Weinberger
authors.forename: Johnson F
authors.initials: JF
authors.lastname: Tsui
authors.forename: Jyoti
authors.initials: J
authors.lastname: Chouhan
authors.forename: Ruhee
authors.initials: R
authors.lastname: Sidhu
authors.forename: Kamron
authors.initials: K
authors.lastname: Saleem
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D012189:Retrospective Studies; D053825:Suburethral Slings / Q000009:adverse effects*; D017211:Treatment Failure; D013520:Urologic Surgical Procedures / Q000379:methods
keywords: LUTSS; Lower Urinary Tract Symptom Score; OAB; PGI-I; Patient Global Impression of Improvement; Qmax; SUI; TOT; TVT®; UTI; maximum flow rate; overactive bladder; postoperative complications; salvage therapy; stress urinary incontinence; suburethral slings; surgical mesh; tension-free vaginal tape; transobturator tape; urinary incontinence; urinary tract infection