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- Title
Evaluation and management of the patient with a failed midurethral synthetic sling.
- Authors
Gormley, E. Ann
- Abstract
While most women will do well following placement of a midurethral sling (MUS), a substantial minority do experience surgical failure. There are several risk factors that can help identify a patient at higher risk for failure, including body mass index greater than 25 kg/m², mixed incontinence, previous continence surgery, intrinsic sphincter deficiency, and diabetes. At the present time, there is no evidence-based guidance for which intervention to use following failure. Careful evaluation of patient characteristics will help guide subsequent management. Surgical failure of a midurethral sling (MUS) is defined as a postoperative patient experiencing incontinence the same or worse than it was preoperatively. The patient may ultimately be found to have persistent or recurrent stress urinary incontinence (SUI), persistent or de novo urgency incontinence or, rarely, a fistula. Failure can be defined by the surgeon's or patient's assessment of cure or improvement at the last follow-up visit, or it can be strictly assessed using subjective or objective criteria, including patient satisfaction at a minimum follow-up of 12 months. This review will discuss the frequency of MUS failure, how to identify a patient at risk for failure, and provide suggestions on how to manage patients following failure.
- Publication
Canadian Urological Association Journal, 2012, pS123
- ISSN
1911-6470
- Publication type
Academic Journal
- DOI
10.5489/cuaj.1463