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Surgery Insight: management of failed sling surgery for female stress urinary incontinence

Nature Clinical Practice Urology volume 3, pages 666–674 (2006)Cite this article

Abstract

Sling surgery has replaced Burch colposuspension as the most common surgery for women with stress urinary incontinence (SUI). While incontinence surgery has become a routine part of urologic care, the management of surgical complications and recurrent incontinence can be quite difficult. It is important that the urologic surgeon is well informed about the most common complications that are associated with sling surgery, and how to best manage them. In addition, the management of recurrent incontinence following sling surgery should follow a stepwise approach, with appropriate diagnostic studies, conservative treatment if possible, and surgery if necessary. While sling surgery in the patient with urethral hypermobility is often straightforward, reoperation for recurrent incontinence can be more technically challenging. In the patient with a fixed and incompetent urethra, periurethral bulking agents, pubovaginal sling, spiral sling, or artificial urinary sphincter placement may be indicated.

Key Points

  • Sling surgery is associated with predictable, yet often unavoidable complications; intraoperative complications include bleeding and urethral or bladder injury

  • Postoperative complications can include sling extrusion and erosion, osteitis and osteomyelitis, urinary retention and voiding dysfunction, and recurrent urinary incontinence

  • Careful evaluation of the patient experiencing postoperative complications or recurrent urinary incontinence requires a detailed history and physical examination, and in difficult diagnostic cases, urodynamics might be indicated; only after an accurate diagnosis is made can rational treatment be offered

  • Conservative management usually involves behavioral therapy and pharmacotherapy, followed by surgical intervention if necessary

  • Repeat operation for a failed sling is associated with a higher complication rate and a lower success rate than initial sling surgery

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Figure 1: Eroded urethral sling in a patient who presented with recurrent urinary tract infections.
Figure 2: Lateral bladder wall with sling inadvertently placed intravesically.
Figure 3: Algorithm for the evaluation and treatment of postoperative voiding dysfunction and recurrent incontinence.
Figure 4: Cystoscopic demonstration of intrinsic sphincter deficiency.

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Authors and Affiliations

  1. Associate Professor of Surgery and Urology, and Chief, Section of Urology, University of Arizona Health Sciences Center, Tucson, AZ, USA

    Craig V Comiter

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  1. Craig V Comiter
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Correspondence to Craig V Comiter.

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Comiter, C. Surgery Insight: management of failed sling surgery for female stress urinary incontinence. Nat Rev Urol 3, 666–674 (2006). https://doi.org/10.1038/ncpuro0657

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