Commentary
Over the past 2 decades, midurethral slings, both via a retropubic and a transobturator approach have become the first-line therapy for the surgical correction of female stress urinary incontinence. Not only are cure rates excellent for both techniques, but the incidence of complications are low.
Intraoperatively, major concerns include vascular lesions, nerve injuries, and injuries to the bowel. More minor concerns are related to the bladder.
Dr. Charles E. Miller
Perioperative complications include retropubic hematoma, blood loss, urinary tract infection, and spondylitis. Postoperative risks include transient versus permanent urinary retention, vaginal versus urethral erosion, de novo urgency, bladder erosion, and urethral obstruction.
In this edition of Master Class in gynecologic surgery, I am pleased to solicit the help of Dr. Charles Rardin, who will make recommendations regarding the management of some of the most common complications related to midurethral sling procedures.
Dr. Rardin is the director of the Robotic Surgery Program at Women & Infants Hospital of Rhode Island, in Providence; a surgeon in Women & Infants’ division of urogynecology and Reconstructive Pelvic Surgery; and is the director of the hospital’s fellowship urogynecology and reconstructive pelvic surgery.
Dr. Miller is clinical associate professor at the University of Illinois at Chicago, immediate past president of the International Society for Gynecologic Endoscopy (ISGE), and a past president of the AAGL. He is a reproductive endocrinologist and minimally invasive gynecologic surgeon in private practice in Naperville, Ill., and Schaumburg, Ill.; the director of minimally invasive gynecologic surgery and the director of the AAGL/SRS fellowship in minimally invasive gynecologic surgery at Advocate Lutheran General Hospital, Park Ridge, Ill.; and the medical editor of this column, Master Class. Dr. Miller is a consultant and on the speaker’s bureau for Ethicon.