title: Functional outcomes following surgical management of pain, exposure or extrusion following a suburethral tape insertion for urinary stress incontinence.
abstract: OBJECTIVE
  Surgical revision of a tape inserted for urinary stress incontinence may be indicated for pain, or tape exposure or extrusion. This study assesses the clinical outcomes of revision surgery.
  
  
  METHODS
  A retrospective review of 47 consecutive women who underwent surgical revision for the indications of pain, tape exposure or tape extrusion.
  
  
  RESULTS
  Forty-seven women underwent revision. 29 women (62 %) had initial tape placement at another institution. Mean interval between placement and revision was 30 months. 39 women (83 %) had an identifiable tape exposure or extrusion with or without pain, while 8 women (17 %) presented with pain alone. 11 (23 %) of the tapes were infected clinically and histologically at revision, 10 of the 11 (90 %) being of a multifilament type. In 23 (49 %) cases, the revision aimed to completely remove the tape. Partial excision 24 (51 %) was reserved for localised exposures or extrusions where infection was not suspected. A concomitant continence procedure was performed in 9(19 %) at the time of tape revision. None of these 9 women has experienced recurrent stress urinary incontinence (SUI) compared with 11 out of 38 women (29 %) requiring further stress incontinence surgery when no continence procedure was performed (Fisher's exact p = 0.092). Eight out of 47 underwent revision surgery for pain with no identifiable exposure or extrusion; pain subsequently resolved in all 8 women.
  
  
  CONCLUSIONS
  Excision is an effective treatment for tape exposure and pain whether infection is present or not. Tapes of a multifilament type are strongly associated with infection. When infection is present, complete sling removal is necessary. A concomitant procedure to prevent recurrent SUI should be considered if tape excision is planned and infection is not suspected.
authors.affiliation: Department of Urogynaecology, Mercy Hospital for Women, Melbourne, 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: Yik
authors.initials: Y
authors.lastname: Lim
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Edwards
authors.forename: Joseph K
authors.initials: JK
authors.lastname: Lee
mesh_terms: D020878:Device Removal; D004868:Equipment Failure; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D015994:Incidence; D017699:Pelvic Pain / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D053825:Suburethral Slings; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000601:surgery*