Mark D. Walters, MD Dr. Walters is Professor and Vice Chair of Gynecology, Center of Urogynecology and Pelvic Floor Disorders, ObGyn and Women’s Health Institute, Cleveland Clinic, Cleveland, Ohio. He is Co-Editor-in-Chief of the on-line surgical education journal of the International Academy of Pelvic Surgery (IAPS) (www.academyofpelvicsurgery.com.
Anne M. Weber, MD Dr. Weber is a consultant to the International Academy of Pelvic Surgery (IAPS).
Dr. Walters reports that he is a consultant to and lecturer for American Medical Systems and has received research
Patients who have recurrent SUI with mesh complication: Pubovaginal fascial sling or Burch colposuspension. These non-mesh options are effective for recurrent SUI and can be performed at the same time as mesh removal. They carry higher surgical morbidity, longer operative time, and greater postoperative voiding dysfunction.
An informed patient can help guide the approach
The retropubic and TOT approaches to tension-free midurethral slings are similar in effectiveness. Most women experience significant improvement of SUI symptoms after sling placement, although many women continue to have some urinary symptoms.
Depending on their training, experience, and personal results—as well as the preferences of an informed patient—surgeons may recommend one approach over the other. In addition, certain clinical situations may favor one sling over another. Studies with longer-term follow-up in different patient subgroups are needed to adequately counsel women about the durability of results.
CASE: Resolved
After discussing the options with your patient, she opts to undergo anterior prolapse repair with concurrent placement of a TOT sling. The surgery is completed without complication. She is discharged later that day without a catheter after demonstrating normal voiding with low residual urine volume. Postoperatively, she reports mild pain referred to the groin. You instruct her to take nonsteroidal anti-inflammatory drugs for pain relief. On her postoperative visit, she reports that the pain is gone and the SUI has almost completely resolved.
