Management of sling surgery complications

Iyer, J., and Rane, A. (2015) Management of sling surgery complications. In: Tamilselvi, A., and Rane, Ajay, (eds.) Principles and Practice of Urogynaecology. Springer, New Delhi, India, pp. 69-76.

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The management of urodynamically proven stress urinary incontinence underwent a paradigm shift with the focus changing from bladder neck suspension to support of the mid-urethra in the last two decades. This has resulted in the replacement of Burch colposuspension and pubo-vaginal slings to synthetic mid-urethral slings as the primary surgical option in women with stress urinary incontinence (SUI). The introduction of synthetic mid-urethral slings has resulted in good objective and subjective cure rates but can be associated with complications that pose a challenge to the treating surgeon. Surgical treatment for SUI has rapidly evolved, and the initially introduced mid-urethral sling, retropubic tension-free vaginal tape (TVT), is accepted worldwide as a standard treatment for women suffering from SUI. However, slings have been associated with a few early and delayed complications which may result in varying degrees of morbidity. Serious complications such as bowel injury, major vascular injury, and even death have been reported with mid-urethral sling procedures.

Sling complications are related to the sling type, surgical technique and time elapsed postsurgery. Though there are numerous devices available in the market, three different types of mid-urethral slings are commonly described in current practice, namely-retropubic slings (TVT, GYNECARE TM; AMS TM, RetroArc), transobturator slings (AMS TM, Monarc; TVT-O, GYNECARE TM ) and single-incision mini-slings (AMS TM, MiniArc). The rationale for choice of sling has been discussed elsewhere in this book and the surgical technique varies with the type of sling chosen which in turn is intricately related to type of complications seen with slings. This chapter deals with the management of synthetic mid-urethral sling complications in the intra-operative and postoperative period.

Item ID: 44479
Item Type: Book Chapter (Research - B1)
ISBN: 978-81-322-1692-6
Date Deposited: 21 Jun 2016 02:18
Downloads: Total: 2
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