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Long-term outcomes of anti-incontinence surgery and subsequent transvaginal sling incision for urethral obstruction

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Abstract

Introduction and hypothesis

The suburethral sling procedure has been widely used as the first-line treatment for stress urinary incontinence (SUI) in women. Although the success rate is high, difficult urination and urine retention can occur in a small portion of patients. A transvaginal sling incision can solve this problem but recurrent SUI may occur. This study investigated the long-term outcomes of women who underwent the pubovaginal sling (PVS) procedure and subsequent transvaginal sling incision for urethral obstruction.

Methods

We retrospectively reviewed the voiding conditions of women who underwent transvaginal sling incision owing to bladder outlet obstruction after the PVS procedure over the past two decades. Urodynamic study was performed before and after each operation. The patients’ Global Impression of Improvement (PGI-I) and quality of life index (QoL-I) due to urinary symptoms were used for outcome evaluation.

Results

Among 405 women who underwent PVS procedure, 14 (3.5%) underwent subsequent transvaginal sling incision. The main symptoms were severe dysuria, followed by urinary retention or severe wound discomfort. The average interval between the two operations was 147.6 ± 353.6 days (range 3~1,344). The mean follow-up time after sling incision was 91.1 ± 50.7 months. At follow-up, 12 patients (85.7%) could maintain urinary continence whereas 2 had urgency incontinence. Ten patients (71.4%) were satisfied with their quality of life postoperatively.

Conclusions

Transvaginal sling incision is effective for urethral obstruction after PVS procedure. Voiding dysfunction after PVS could be resolved via sling incision. Most patients could maintain urinary continence and reported good satisfaction.

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Authors and Affiliations

  1. Department of Urology, Buddhist Tzu Chi General Hospital, 707 Chung-Yang Road, Section 3, Hualien, Taiwan, 970

    Shu-Yu Wu & Hann-Chorng Kuo

  2. Tzu Chi University, Hualien, Taiwan

    Shu-Yu Wu & Hann-Chorng Kuo

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  1. Shu-Yu Wu
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  2. Hann-Chorng Kuo
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Correspondence to Hann-Chorng Kuo.

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Wu, SY., Kuo, HC. Long-term outcomes of anti-incontinence surgery and subsequent transvaginal sling incision for urethral obstruction. Int Urogynecol J 30, 761–766 (2019). https://doi.org/10.1007/s00192-018-3733-0

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  • DOI: https://doi.org/10.1007/s00192-018-3733-0

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