The Experts below are selected from a list of 2418 Experts worldwide ranked by ideXlab platform
Joseph I. Schaffer - One of the best experts on this subject based on the ideXlab platform.
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Urethral erosion of tension-free vaginal tape presenting as recurrent stress urinary incontinence
International Urogynecology Journal, 2004Co-Authors: Shanna D. Atnip, Kristin N. Williams, Joseph I. SchafferAbstract:The Suburethral Sling with tension-free vaginal tape (TVT) has become a popular treatment for stress urinary incontinence. Erosion of the mesh into the urethra is rare, usually presenting with hematuria, pain, voiding dysfunction or urge incontinence. A patient with stress incontinence was treated with a TVT Suburethral Sling. One month later, symptoms of recurrent stress incontinence developed. Cystourethroscopy revealed urethral mesh erosion. Surgical removal involved cystourethroscopic-assisted transurethral resection of the mesh, followed by vaginal dissection and periurethral withdrawal. Urethral mesh erosion should be considered in a patient who presents with atypical symptoms after being treated with a Suburethral Sling. It is important to obtain a detailed history and have a high clinical index of suspicion for erosion. Careful and comprehensive urethroscopy, in addition to cystoscopy, should be a mandatory part of the TVT procedure. Further study is needed to determine the optimal technique for mesh removal.
Cathryn Glazener - One of the best experts on this subject based on the ideXlab platform.
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traditional Suburethral Sling operations for urinary incontinence in women
Cochrane Database of Systematic Reviews, 2017Co-Authors: Lucky Saraswat, June D Cody, Haroon Rehman, Muhammad Imran Omar, Patricia Aluko, Cathryn GlazenerAbstract:Background Stress urinary incontinence constitutes a significant health and economic burden to society. Traditional Suburethral Slings are one of the surgical operations used to treat women with symptoms of stress urinary incontinence. Objectives To determine the effects of traditional Suburethral Slings on stress or mixed incontinence in comparison with other management options. Search methods We searched the Cochrane Incontinence Group Specialised Register (searched 3 June 2010) and the reference lists of relevant articles. Selection criteria Randomised or quasi-randomised trials that included traditional Suburethral Slings for the treatment of stress or mixed urinary incontinence. Data collection and analysis At least three reviewers independently extracted data from included trials onto a standard form and assessed trial methodological quality. The data abstracted were relevant to predetermined outcome measures. Where appropriate, we calculated a summary statistic: a relative risk for dichotomous data and a weighted mean difference for continuous data. Main results We included 26 trials involving 2284 women. The quality of evidence was moderate for most trials and there was generally short follow-up ranging from 6 to 24 months. One medium-sized trial compared traditional Suburethral Sling operations with oxybutynin in the treatment of women with mixed urinary incontinence. Surgery appeared to be more effective than drugs in treating participant-reported incontinence (n = 75, risk ratio (RR) 0.18, 95% confidence interval (CI) 0.08 to 0.43). One trial found that traditional Slings were more effective than transurethral injectable treatment (RR for clinician-assessed incontinence within a year 0.21, 95% CI 0.09 to 0.21) Seven trials compared Slings with open abdominal retropubic colposuspension. Participant-reported incontinence was lower with the Slings after one year (RR 0.75, 95% CI 0.62 to 0.90), but not when assessed by clinicians. Colposuspension, however, was associated with fewer peri-operative complications, shorter duration of use of indwelling catheter and less long-term voiding dysfunction. One study showed there was a 20% lower risk of bladder perforation with the Sling procedure but a 50% increase in urinary tract infection with the Sling procedure compared with colposuspension. Fewer women developed prolapse after Slings (compared with after colposuspension) in two small trials but this did not reach statistical significance. Twelve trials addressed the comparison between traditional Sling operations and minimally invasive Sling operations. These seemed to be equally effective in the short term (RR for incontinence within first year 0.97, 95% CI 0.78 to 1.20) but minimally invasive Slings had a shorter operating time, fewer peri-operative complications (other than bladder perforation) and some evidence of less post-operative voiding dysfunction and detrusor symptoms. Six trials compared one type of traditional Sling with another. Materials included porcine dermis, lyophilised dura mater, fascia lata, vaginal wall, autologous dermis and rectus fascia. Participant-reported improvement rates within the first year favoured the traditional autologous material rectus fascia over other biological materials (RR 0.45, 95% CI 0.21 to 0.98). There were more complications with the use of non-absorbable Gore-Tex in one trial. Data for comparison of bladder neck needle suspension with Suburethral Slings were inconclusive because they came from a single trial with a small specialised population. No trials compared traditional Suburethral Slings with anterior repair, laparoscopic retropubic colposuspension or artificial sphincters. Most trials did not distinguish between women having surgery for primary or recurrent incontinence when reporting participant characteristics. For most of the comparisons, clinically important differences could not be ruled out. Authors' conclusions Traditional Slings seem to be as effective as minimally invasive Slings, but had higher rates of adverse effects. This should be interpreted with some caution however, as the quality of evidence for the studies was variable, follow-up short and populations small, particularly for identifying complication rates. Tradional Sling procedures appeared to confer a similar cure rate in comparison to open retropubic colposuspension, but the long-term adverse event profile is still unclear. A brief economic commentary (BEC) identified two studies suggesting that traditional Slings may be more cost-effective compared with collagen injection but not cost-effective when compared with minimally invasive Sling operations. Reliable evidence to clarify whether or not traditional Suburethral Slings may be better or worse than other surgical or conservative management options is lacking.
Muhammad Imran Omar - One of the best experts on this subject based on the ideXlab platform.
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traditional Suburethral Sling operations for urinary incontinence in women
Cochrane Database of Systematic Reviews, 2017Co-Authors: Lucky Saraswat, June D Cody, Haroon Rehman, Muhammad Imran Omar, Patricia Aluko, Cathryn GlazenerAbstract:Background Stress urinary incontinence constitutes a significant health and economic burden to society. Traditional Suburethral Slings are one of the surgical operations used to treat women with symptoms of stress urinary incontinence. Objectives To determine the effects of traditional Suburethral Slings on stress or mixed incontinence in comparison with other management options. Search methods We searched the Cochrane Incontinence Group Specialised Register (searched 3 June 2010) and the reference lists of relevant articles. Selection criteria Randomised or quasi-randomised trials that included traditional Suburethral Slings for the treatment of stress or mixed urinary incontinence. Data collection and analysis At least three reviewers independently extracted data from included trials onto a standard form and assessed trial methodological quality. The data abstracted were relevant to predetermined outcome measures. Where appropriate, we calculated a summary statistic: a relative risk for dichotomous data and a weighted mean difference for continuous data. Main results We included 26 trials involving 2284 women. The quality of evidence was moderate for most trials and there was generally short follow-up ranging from 6 to 24 months. One medium-sized trial compared traditional Suburethral Sling operations with oxybutynin in the treatment of women with mixed urinary incontinence. Surgery appeared to be more effective than drugs in treating participant-reported incontinence (n = 75, risk ratio (RR) 0.18, 95% confidence interval (CI) 0.08 to 0.43). One trial found that traditional Slings were more effective than transurethral injectable treatment (RR for clinician-assessed incontinence within a year 0.21, 95% CI 0.09 to 0.21) Seven trials compared Slings with open abdominal retropubic colposuspension. Participant-reported incontinence was lower with the Slings after one year (RR 0.75, 95% CI 0.62 to 0.90), but not when assessed by clinicians. Colposuspension, however, was associated with fewer peri-operative complications, shorter duration of use of indwelling catheter and less long-term voiding dysfunction. One study showed there was a 20% lower risk of bladder perforation with the Sling procedure but a 50% increase in urinary tract infection with the Sling procedure compared with colposuspension. Fewer women developed prolapse after Slings (compared with after colposuspension) in two small trials but this did not reach statistical significance. Twelve trials addressed the comparison between traditional Sling operations and minimally invasive Sling operations. These seemed to be equally effective in the short term (RR for incontinence within first year 0.97, 95% CI 0.78 to 1.20) but minimally invasive Slings had a shorter operating time, fewer peri-operative complications (other than bladder perforation) and some evidence of less post-operative voiding dysfunction and detrusor symptoms. Six trials compared one type of traditional Sling with another. Materials included porcine dermis, lyophilised dura mater, fascia lata, vaginal wall, autologous dermis and rectus fascia. Participant-reported improvement rates within the first year favoured the traditional autologous material rectus fascia over other biological materials (RR 0.45, 95% CI 0.21 to 0.98). There were more complications with the use of non-absorbable Gore-Tex in one trial. Data for comparison of bladder neck needle suspension with Suburethral Slings were inconclusive because they came from a single trial with a small specialised population. No trials compared traditional Suburethral Slings with anterior repair, laparoscopic retropubic colposuspension or artificial sphincters. Most trials did not distinguish between women having surgery for primary or recurrent incontinence when reporting participant characteristics. For most of the comparisons, clinically important differences could not be ruled out. Authors' conclusions Traditional Slings seem to be as effective as minimally invasive Slings, but had higher rates of adverse effects. This should be interpreted with some caution however, as the quality of evidence for the studies was variable, follow-up short and populations small, particularly for identifying complication rates. Tradional Sling procedures appeared to confer a similar cure rate in comparison to open retropubic colposuspension, but the long-term adverse event profile is still unclear. A brief economic commentary (BEC) identified two studies suggesting that traditional Slings may be more cost-effective compared with collagen injection but not cost-effective when compared with minimally invasive Sling operations. Reliable evidence to clarify whether or not traditional Suburethral Slings may be better or worse than other surgical or conservative management options is lacking.
June D Cody - One of the best experts on this subject based on the ideXlab platform.
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traditional Suburethral Sling operations for urinary incontinence in women
Cochrane Database of Systematic Reviews, 2017Co-Authors: Lucky Saraswat, June D Cody, Haroon Rehman, Muhammad Imran Omar, Patricia Aluko, Cathryn GlazenerAbstract:Background Stress urinary incontinence constitutes a significant health and economic burden to society. Traditional Suburethral Slings are one of the surgical operations used to treat women with symptoms of stress urinary incontinence. Objectives To determine the effects of traditional Suburethral Slings on stress or mixed incontinence in comparison with other management options. Search methods We searched the Cochrane Incontinence Group Specialised Register (searched 3 June 2010) and the reference lists of relevant articles. Selection criteria Randomised or quasi-randomised trials that included traditional Suburethral Slings for the treatment of stress or mixed urinary incontinence. Data collection and analysis At least three reviewers independently extracted data from included trials onto a standard form and assessed trial methodological quality. The data abstracted were relevant to predetermined outcome measures. Where appropriate, we calculated a summary statistic: a relative risk for dichotomous data and a weighted mean difference for continuous data. Main results We included 26 trials involving 2284 women. The quality of evidence was moderate for most trials and there was generally short follow-up ranging from 6 to 24 months. One medium-sized trial compared traditional Suburethral Sling operations with oxybutynin in the treatment of women with mixed urinary incontinence. Surgery appeared to be more effective than drugs in treating participant-reported incontinence (n = 75, risk ratio (RR) 0.18, 95% confidence interval (CI) 0.08 to 0.43). One trial found that traditional Slings were more effective than transurethral injectable treatment (RR for clinician-assessed incontinence within a year 0.21, 95% CI 0.09 to 0.21) Seven trials compared Slings with open abdominal retropubic colposuspension. Participant-reported incontinence was lower with the Slings after one year (RR 0.75, 95% CI 0.62 to 0.90), but not when assessed by clinicians. Colposuspension, however, was associated with fewer peri-operative complications, shorter duration of use of indwelling catheter and less long-term voiding dysfunction. One study showed there was a 20% lower risk of bladder perforation with the Sling procedure but a 50% increase in urinary tract infection with the Sling procedure compared with colposuspension. Fewer women developed prolapse after Slings (compared with after colposuspension) in two small trials but this did not reach statistical significance. Twelve trials addressed the comparison between traditional Sling operations and minimally invasive Sling operations. These seemed to be equally effective in the short term (RR for incontinence within first year 0.97, 95% CI 0.78 to 1.20) but minimally invasive Slings had a shorter operating time, fewer peri-operative complications (other than bladder perforation) and some evidence of less post-operative voiding dysfunction and detrusor symptoms. Six trials compared one type of traditional Sling with another. Materials included porcine dermis, lyophilised dura mater, fascia lata, vaginal wall, autologous dermis and rectus fascia. Participant-reported improvement rates within the first year favoured the traditional autologous material rectus fascia over other biological materials (RR 0.45, 95% CI 0.21 to 0.98). There were more complications with the use of non-absorbable Gore-Tex in one trial. Data for comparison of bladder neck needle suspension with Suburethral Slings were inconclusive because they came from a single trial with a small specialised population. No trials compared traditional Suburethral Slings with anterior repair, laparoscopic retropubic colposuspension or artificial sphincters. Most trials did not distinguish between women having surgery for primary or recurrent incontinence when reporting participant characteristics. For most of the comparisons, clinically important differences could not be ruled out. Authors' conclusions Traditional Slings seem to be as effective as minimally invasive Slings, but had higher rates of adverse effects. This should be interpreted with some caution however, as the quality of evidence for the studies was variable, follow-up short and populations small, particularly for identifying complication rates. Tradional Sling procedures appeared to confer a similar cure rate in comparison to open retropubic colposuspension, but the long-term adverse event profile is still unclear. A brief economic commentary (BEC) identified two studies suggesting that traditional Slings may be more cost-effective compared with collagen injection but not cost-effective when compared with minimally invasive Sling operations. Reliable evidence to clarify whether or not traditional Suburethral Slings may be better or worse than other surgical or conservative management options is lacking.
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The Cochrane Library - Traditional Suburethral Sling operations for urinary incontinence in women
Cochrane Database of Systematic Reviews, 2017Co-Authors: Haroon Rehman, June D Cody, C A Bezerra, H Bruschini, Patricia AlukoAbstract:Background Stress urinary incontinence constitutes a significant health and economic burden to society. Traditional Suburethral Slings are one of the surgical operations used to treat women with symptoms of stress urinary incontinence. Objectives To determine the effects of traditional Suburethral Slings on stress or mixed incontinence in comparison with other management options. Search methods We searched the Cochrane Incontinence Group Specialised Register (searched 3 June 2010) and the reference lists of relevant articles. Selection criteria Randomised or quasi-randomised trials that included traditional Suburethral Slings for the treatment of stress or mixed urinary incontinence. Data collection and analysis At least three reviewers independently extracted data from included trials onto a standard form and assessed trial methodological quality. The data abstracted were relevant to predetermined outcome measures. Where appropriate, we calculated a summary statistic: a relative risk for dichotomous data and a weighted mean difference for continuous data. Main results We included 26 trials involving 2284 women. The quality of evidence was moderate for most trials and there was generally short follow-up ranging from 6 to 24 months. One medium-sized trial compared traditional Suburethral Sling operations with oxybutynin in the treatment of women with mixed urinary incontinence. Surgery appeared to be more effective than drugs in treating participant-reported incontinence (n = 75, risk ratio (RR) 0.18, 95% confidence interval (CI) 0.08 to 0.43). One trial found that traditional Slings were more effective than transurethral injectable treatment (RR for clinician-assessed incontinence within a year 0.21, 95% CI 0.09 to 0.21) Seven trials compared Slings with open abdominal retropubic colposuspension. Participant-reported incontinence was lower with the Slings after one year (RR 0.75, 95% CI 0.62 to 0.90), but not when assessed by clinicians. Colposuspension, however, was associated with fewer peri-operative complications, shorter duration of use of indwelling catheter and less long-term voiding dysfunction. One study showed there was a 20% lower risk of bladder perforation with the Sling procedure but a 50% increase in urinary tract infection with the Sling procedure compared with colposuspension. Fewer women developed prolapse after Slings (compared with after colposuspension) in two small trials but this did not reach statistical significance. Twelve trials addressed the comparison between traditional Sling operations and minimally invasive Sling operations. These seemed to be equally effective in the short term (RR for incontinence within first year 0.97, 95% CI 0.78 to 1.20) but minimally invasive Slings had a shorter operating time, fewer peri-operative complications (other than bladder perforation) and some evidence of less post-operative voiding dysfunction and detrusor symptoms. Six trials compared one type of traditional Sling with another. Materials included porcine dermis, lyophilised dura mater, fascia lata, vaginal wall, autologous dermis and rectus fascia. Participant-reported improvement rates within the first year favoured the traditional autologous material rectus fascia over other biological materials (RR 0.45, 95% CI 0.21 to 0.98). There were more complications with the use of non-absorbable Gore-Tex in one trial. Data for comparison of bladder neck needle suspension with Suburethral Slings were inconclusive because they came from a single trial with a small specialised population. No trials compared traditional Suburethral Slings with anterior repair, laparoscopic retropubic colposuspension or artificial sphincters. Most trials did not distinguish between women having surgery for primary or recurrent incontinence when reporting participant characteristics. For most of the comparisons, clinically important differences could not be ruled out. Authors' conclusions Traditional Slings seem to be as effective as minimally invasive Slings, but had higher rates of adverse effects. This should be interpreted with some caution however, as the quality of evidence for the studies was variable, follow-up short and populations small, particularly for identifying complication rates. Tradional Sling procedures appeared to confer a similar cure rate in comparison to open retropubic colposuspension, but the long-term adverse event profile is still unclear. A brief economic commentary (BEC) identified two studies suggesting that traditional Slings may be more cost-effective compared with collagen injection but not cost-effective when compared with minimally invasive Sling operations. Reliable evidence to clarify whether or not traditional Suburethral Slings may be better or worse than other surgical or conservative management options is lacking.
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minimally invasive synthetic Suburethral Sling operations for stress urinary incontinence in women
Cochrane Database of Systematic Reviews, 2009Co-Authors: Joseph Ogah, June D Cody, Lynne RogersonAbstract:Background Stress urinary incontinence (SUI) is a common condition affecting up to 30% of women. Minimally invasive synthetic Suburethral Sling operations are among the latest forms of procedures introduced to treat SUI. Objectives To assess the effects of minimally invasive synthetic Suburethral Sling operations for treatment of SUI, urodynamic stress incontinence (USI) or mixed urinary incontinence (MUI) in women. Search methods We searched the Cochrane Incontinence Group Specialised Register (searched 20 March 2008), MEDLINE (January 1950 to April 2008), EMBASE (January 1988 to April 2008), CINAHL (January 1982 to April 2008), AMED (January 1985 to April 2008), the UK National Research Register, ClinicalTrials.gov, and reference lists of relevant articles. Selection criteria Randomised or quasi-randomised controlled trials amongst women with SUI, USI or symptoms of stress or mixed urinary incontinence, in which at least one trial arm involved a minimally invasive synthetic Suburethral Sling operations. Data collection and analysis Two review authors assessed the methodological quality of potentially eligible studies and independently extracted data from the included trials. Main results Sixty two trials involving 7101 women were included. The quality of evidence was moderate for most trials. Minimally invasive synthetic Suburethral Sling operations appeared to be as effective as traditional Suburethral Slings ( trials, n = 599, Risk Ratio (RR) 1.03, 95% Confidence Interval (CI) 0.94 to 1.13) but with shorter operating time and less post-operative voiding dysfunction and de novo urgency symptoms. Minimally invasive synthetic Suburethral Sling operations appeared to be as effective as open retropubic colposuspension (subjective cure rate at 12 months RR 0.96, 95% CI 0.90 to 1.03; at 5 years RR 0.91, 95% CI 0.74 to 1.12) with fewer perioperative complications, less postoperative voiding dysfunction, shorter operative time and hospital stay but significantly more bladder perforations (6% versus 1%, RR 4.24, 95% CI 1.71 to 10.52). There was conflicting evidence about the effectiveness of minimally invasive synthetic Suburethral Sling operations compared to laparoscopic colposuspension in the short term (objective cure, RR 1.15, 95% CI 1.06 to 1.24; subjective cure RR 1.11, 95% CI 0.99 to 1.24). Minimally invasive synthetic Suburethral Sling operations had significantly less de novo urgency and urgency incontinence, shorter operating time, hospital stay and time to return to daily activities. A retropubic bottom-to-top route was more effective than top-to-bottom route (RR 1.10, 95% CI 1.01 to 1.20; RR 1.06, 95% CI 1.01 to 1.11) and incurred significantly less voiding dysfunction, bladder perforations and tape erosions. Monofilament tapes had significantly higher objective cure rates (RR 1.15, 95% CI 1.02 to 1.30) compared to multifilament tapes and fewer tape erosions (1.3% versus 6% RR 0.25, 95% CI 0.06 to 1.00). The obturator route was less favourable than the retropubic route in objective cure (84% versus 88%; RR 0.96, 95% CI 0.93 to 0.99; 17 trials, n = 2434), although there was no difference in subjective cure rates. However, there was less voiding dysfunction, blood loss, bladder perforation (0.3% versus 5.5%, RR 0.14, 95% CI 0.07 to 0.26) and shorter operating time with the obturator route. Authors' conclusions The current evidence base suggests that minimally invasive synthetic Suburethral Sling operations are as effective as traditional Suburethral Slings, open retropubic colposuspension and laparoscopic colposuspension in the short term but with less postoperative complications. Objective cure rates are higher with retropubic tapes than with obturator tapes but retropubic tapes attract more complications. Most of the trials had short term follow up and the quality of the evidence was variable.
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The Cochrane Library - Minimally invasive synthetic Suburethral Sling operations for stress urinary incontinence in women
Cochrane Database of Systematic Reviews, 2009Co-Authors: Joseph Ogah, June D Cody, Lynne RogersonAbstract:Background Stress urinary incontinence (SUI) is a common condition affecting up to 30% of women. Minimally invasive synthetic Suburethral Sling operations are among the latest forms of procedures introduced to treat SUI. Objectives To assess the effects of minimally invasive synthetic Suburethral Sling operations for treatment of SUI, urodynamic stress incontinence (USI) or mixed urinary incontinence (MUI) in women. Search methods We searched the Cochrane Incontinence Group Specialised Register (searched 20 March 2008), MEDLINE (January 1950 to April 2008), EMBASE (January 1988 to April 2008), CINAHL (January 1982 to April 2008), AMED (January 1985 to April 2008), the UK National Research Register, ClinicalTrials.gov, and reference lists of relevant articles. Selection criteria Randomised or quasi-randomised controlled trials amongst women with SUI, USI or symptoms of stress or mixed urinary incontinence, in which at least one trial arm involved a minimally invasive synthetic Suburethral Sling operations. Data collection and analysis Two review authors assessed the methodological quality of potentially eligible studies and independently extracted data from the included trials. Main results Sixty two trials involving 7101 women were included. The quality of evidence was moderate for most trials. Minimally invasive synthetic Suburethral Sling operations appeared to be as effective as traditional Suburethral Slings ( trials, n = 599, Risk Ratio (RR) 1.03, 95% Confidence Interval (CI) 0.94 to 1.13) but with shorter operating time and less post-operative voiding dysfunction and de novo urgency symptoms. Minimally invasive synthetic Suburethral Sling operations appeared to be as effective as open retropubic colposuspension (subjective cure rate at 12 months RR 0.96, 95% CI 0.90 to 1.03; at 5 years RR 0.91, 95% CI 0.74 to 1.12) with fewer perioperative complications, less postoperative voiding dysfunction, shorter operative time and hospital stay but significantly more bladder perforations (6% versus 1%, RR 4.24, 95% CI 1.71 to 10.52). There was conflicting evidence about the effectiveness of minimally invasive synthetic Suburethral Sling operations compared to laparoscopic colposuspension in the short term (objective cure, RR 1.15, 95% CI 1.06 to 1.24; subjective cure RR 1.11, 95% CI 0.99 to 1.24). Minimally invasive synthetic Suburethral Sling operations had significantly less de novo urgency and urgency incontinence, shorter operating time, hospital stay and time to return to daily activities. A retropubic bottom-to-top route was more effective than top-to-bottom route (RR 1.10, 95% CI 1.01 to 1.20; RR 1.06, 95% CI 1.01 to 1.11) and incurred significantly less voiding dysfunction, bladder perforations and tape erosions. Monofilament tapes had significantly higher objective cure rates (RR 1.15, 95% CI 1.02 to 1.30) compared to multifilament tapes and fewer tape erosions (1.3% versus 6% RR 0.25, 95% CI 0.06 to 1.00). The obturator route was less favourable than the retropubic route in objective cure (84% versus 88%; RR 0.96, 95% CI 0.93 to 0.99; 17 trials, n = 2434), although there was no difference in subjective cure rates. However, there was less voiding dysfunction, blood loss, bladder perforation (0.3% versus 5.5%, RR 0.14, 95% CI 0.07 to 0.26) and shorter operating time with the obturator route. Authors' conclusions The current evidence base suggests that minimally invasive synthetic Suburethral Sling operations are as effective as traditional Suburethral Slings, open retropubic colposuspension and laparoscopic colposuspension in the short term but with less postoperative complications. Objective cure rates are higher with retropubic tapes than with obturator tapes but retropubic tapes attract more complications. Most of the trials had short term follow up and the quality of the evidence was variable.
Shanna D. Atnip - One of the best experts on this subject based on the ideXlab platform.
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Urethral erosion of tension-free vaginal tape presenting as recurrent stress urinary incontinence
International Urogynecology Journal, 2004Co-Authors: Shanna D. Atnip, Kristin N. Williams, Joseph I. SchafferAbstract:The Suburethral Sling with tension-free vaginal tape (TVT) has become a popular treatment for stress urinary incontinence. Erosion of the mesh into the urethra is rare, usually presenting with hematuria, pain, voiding dysfunction or urge incontinence. A patient with stress incontinence was treated with a TVT Suburethral Sling. One month later, symptoms of recurrent stress incontinence developed. Cystourethroscopy revealed urethral mesh erosion. Surgical removal involved cystourethroscopic-assisted transurethral resection of the mesh, followed by vaginal dissection and periurethral withdrawal. Urethral mesh erosion should be considered in a patient who presents with atypical symptoms after being treated with a Suburethral Sling. It is important to obtain a detailed history and have a high clinical index of suspicion for erosion. Careful and comprehensive urethroscopy, in addition to cystoscopy, should be a mandatory part of the TVT procedure. Further study is needed to determine the optimal technique for mesh removal.
