Presentation and management of urethral erosion caused by mid-urethral sling.

Abstract

Background: Mid-urethral slings (MUS) have been the standard of care in surgical management of female stress urinary incontinence (SUI) internationally. Complications including pain and erosion has led to a temporary "pause" of their use in the UK and Ireland. We report on our experience to date on patient presentation, operative management, and post-operative outcomes in management of MUS erosion.

Methods: Review of female patients who had partial MUS removal due to urethral erosion over a 7-year period. Data on patient presentation, operative technique, and post-operative outcomes were collected and collated.

Results: A total of 21 patients were identified. Overall, 66% of patients presented with symptoms of urinary tract infection (UTI). Other presentations include overactive bladder symptoms (52%), recurrent incontinence (42%), or dyspareunia (9%). Some patients presented with a combination of these symptoms. Overall, 9 patients had a trans-obturator tape (TOT), 6 had a trans-vaginal tape (TVT), and 4 had unspecified type of MUS. Two patients had 2 previous MUS insertions. Initial operative management with urethroscopy and laser fragmentation in cases with significant MUS calcification was required in 18% (n = 4) of patients. A total of 86% (n = 18) of patients had urethral erosion that required formal urethral repair and a short period with an indwelling catheter. All patients had resolution of their UTI symptoms post procedure. Fifteen patients required further surgical intervention to manage recurrent incontinence after MUS removal.

Conclusion: Partial removal of MUS due to urethral erosion improves patient symptoms. However, the majority have recurrence of SUI and require further intervention.