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Functional outcomes following surgical management of pain, exposure or extrusion following a suburethral tape insertion for urinary stress incontinence

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Abstract

Introduction and hypothesis

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.

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Acknowledgement

There was no outside funding or technical assistance with the production of this article. Reprints will not be available from the authors. PLD, AR, YL and JL are investigators of an ongoing randomised controlled trial of a midurethral tape, for which the Urogynecology Departments have received a research grant from American Medical Systems.

Conflicts of interest

None.

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Authors and Affiliations

  1. Department of Urogynaecology, Mercy Hospital for Women, Melbourne, Victoria, Australia

    Gerard Agnew, Peter L. Dwyer, Yik Lim & Joseph K. Lee

  2. Monash Medical Centre, Melbourne, Victoria, Australia

    Anna Rosamilia, Geoffrey Edwards & Joseph K. Lee

  3. Department of Obstetrics and Gynaecology, National Maternity Hospital, Holles Street, Dublin 2, Ireland

    Gerard Agnew

Authors
  1. Gerard Agnew
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  2. Peter L. Dwyer
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  3. Anna Rosamilia
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  4. Yik Lim
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  5. Geoffrey Edwards
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  6. Joseph K. Lee
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Corresponding author

Correspondence to Gerard Agnew.

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Agnew, G., Dwyer, P.L., Rosamilia, A. et al. Functional outcomes following surgical management of pain, exposure or extrusion following a suburethral tape insertion for urinary stress incontinence. Int Urogynecol J 25, 235–239 (2014). https://doi.org/10.1007/s00192-013-2207-7

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  • DOI: https://doi.org/10.1007/s00192-013-2207-7

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