Management of Complications of Prosthetic Mid-urethral Tape Surgery for Stress Urinary Incontinence in Women.

Abstract

Objective: To propose guidelines for the management of complications of prosthetic mid-urethral tape surgery for stress urinary incontinence in women.

Methods: These guidelines are based on an exhaustive literature review on retropubic and trans-obturator mid-urethral tape complications. The expert panel rated the level of evidence of each study, summarized literature for the treatment of each complication, and proposed guidelines.

Results: Management of these complications is complex and the first treatment is crucial to offer the best functional result to the patient. We propose a standardized approach and guidelines for the management of complications to help physicians to early identify a surgical complication, offer adequate treatment for each complication and provide clear and appropriate information to patients. We detailed management of intraoperative complications as follows: bladder, urethral, vaginal, visceral, and vascular injury; short-term post-operative complications are the following: bleeding/hematoma, voiding dysfunction, pain, infection; and long-term post-operative complications are the following: chronic voiding dysfunction, de novo overactive bladder syndrome, chronic pain, dyspareunia, vaginal, bladder, and urethral tape erosion.

Conclusion: These guidelines may help physicians to improve management of prosthetic mid-urethral sling complications that may occur following stress urinary incontinence surgery.