title: Urgency after a sling: review of the management.
abstract: Urinary urgency after synthetic sling surgery may be persistent urgency that preceded the surgery or de novo urgency that developed after surgery. Recent studies estimate a 40 % rate of persistent urgency after synthetic sling surgery in women with mixed urinary incontinence. Causes of de novo urgency after synthetic sling surgery include postoperative urinary tract infection (7.4-17.4 %), bladder outlet obstruction (1.9-19.7 %), perforation of the urinary tract (0.5-5 %), and idiopathic urgency (0-28 %). Given the temporal relationship of de novo urgency developing after surgery, until proven otherwise, one should assume that the etiology is obstruction. Evaluation includes a history and physical exam, urinalysis, and post-void residual. Cystoscopy and urodynamics may help rule out surgical complications. Management is based on the etiology of the urgency. Urinary tract perforation and bladder outlet obstruction are treated with surgical intervention. Idiopathic de novo or persistent urgency after synthetic sling surgery are treated similarly to idiopathic overactive bladder, with behavioral therapy as first-line treatment, antimuscarinics or beta-agonists as second-line therapy, and intravesical onabotulinumtoxinA or sacral neuromodulation as third-line therapy.
authors: Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Ave Q10-1, Cleveland, OH, 44195, USA, abrahan@ccf.org.
authors: Nitya
authors: N
authors: Abraham
authors: Sandip
authors: S
authors: Vasavada
mesh_terms: D000318:Adrenergic beta-Agonists / Q000627:therapeutic use*; D001521:Behavior Therapy / Q000379:methods*; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D058542:Implantable Neurostimulators; D008160:Lumbosacral Plexus; D018727:Muscarinic Antagonists / Q000627:therapeutic use*; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000628:therapy*; D053825:Suburethral Slings; D016896:Treatment Outcome; D053202:Urinary Incontinence, Urge / Q000628:therapy*
chemical_list: D000318:Adrenergic beta-Agonists; D018727:Muscarinic Antagonists; D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A