EVALUATION OF THE SAFETY OF SLING SURGERY FOR STRESS URINARY INCONTINENCE
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Abstract
To evaluate the safety of correction of stress urinary incontinence in women using various sling surgery techniques.
Materials and methods. An applied, single-center, comparative, non-randomized, retrospective study that included patients who underwent sling surgery for stress urinary incontinence. On the basis of the department of operative gynecology with oncogynecology and day hospital of the State Budgetary Healthcare Institution MO MONIIAG named after V.I. Krasnopolsky examined 395 patients. Group I – 62 patients who underwent sling surgery using the retropubic method (TVT); Group II – 188 patients who underwent sling surgery using the transobturator «outside-in» (TOT) method; Group III – 145 patients who underwent sling surgery using the transobturator «inside-out» method (TVT-O). Intraoperative, early, and late postoperative complications were evaluated in patients with a follow-up period of more than 20 years.
Results. Bladder perforation occurred in 4 (6,5%) patients in group I, 1 (0,5%) patient in group II, and was not observed in group III (p < 0,001). Vaginal mucosal perforation occurred in 5 (2,7%) patients in group II and in 4 (2,8%) patients in group III (p = 0,424). Massive blood loss occurred in 4 (6,5%) patients in group I, 1 (0,6%) patient in group III, and was not observed in group II (p < 0,001). De novo urgency urinary incontinence occurred in 4 (6,5%) patients in group I, 5 (2,7%) patients in group II, and 5 (3,4%) patients in group III (p = 0,375). Chronic pelvic pain in the long-term postoperative period occurred in 2 (3,2%) patients in group I, 6 (3,2%) patients in group II, and 7 (4,8%) patients in group III (p = 0,97). Pain in the inner thigh was noted in 11 (5,9%) patients in group II and in 14 (9,7%) patients in group III (p = 0,031). Acute urinary retention was noted in the postoperative period in 4 (6,5%) patients in group I, 3 (1,6%) patients in group II, and 2 (1,4%) patients in group III (p = 0,056). Vaginal erosions were noted in 2 (3,2%) patients in group I, 4 (2,1%) patients in group II, and 4 (2,8%) patients in group III (p = 0,872).
Conclusions. Sling procedures are a safe and highly effective treatment for stress urinary incontinence in women. With strict adherence to surgical technique, thorough preoperative examination, and adequate postoperative care, the risk of serious complications remains low. However, patients should be informed of the potential risks, including those that may manifest late, and the need for follow-up. Improvements in techniques and materials, as well as in-depth understanding of the mechanisms of complications, continue to improve the safety and effectiveness of sling procedures.
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1. Uysal D, Güven CM, Akgün Kavurmaci S, Sivaslioğlu AA. Long-term efficacy of the single-incision mini-sling procedure using surgeon-tailored mesh. Eur J Obstet Gynecol Reprod Biol. 2023; 287: 59-62. doi: 10.1016/j.ejogrb.2023.06.002
2. Barbič M, Skuk E, Lukanović D, Lebar V, Matjašič M, Lasič M, Barbič M. Impact of Acute or Chronic Post-Void Retention after Midurethral Sling Surgery for Women with Stress Urinary Incontinence: A Systematic Review and Retrospective Analysis of Our Data. Gynecol Obstet Invest. 2025; 90(5): 432-446. doi: 10.1159/000543046
3. Ralphsmith M, Ahern S, Dean J, O'Connell HE, Ruseckaite R. Development of a conceptual framework for a new patient-reported outcome measure for pain in women following mesh surgery for pelvic floor disorders: a qualitative study. Int Urogynecol J. 2023; 34(7): 1541-1550. doi: 10.1007/s00192-022-05425-w
4. Kim Y, Rowley JE, Ortega MV, James KE, Von Bargen E. Incidence of de novo stress urinary incontinence following minimally invasive sacrocolpopexy. Int Urogynecol J. 2023; 34(7): 1599-1605. doi: 10.1007/s00192-022-05434-9
5. Bureau M, Carlson KV. Pelvic organ prolapse: A primer for urologists. Can Urol Assoc J. 2017; 11(6Suppl2): S125-S130. doi: 10.5489/cuaj.4634
6. Buyanova SN, Fedorina SI, Petrakova SA, Glebov TA, Klyushnikov ID, Brylyaeva AE. Pelvic organ prolapse in young women. Russian Bulletin of Obstetrician-Gynecologist. 2023; 23(6-2): 142-148. Russian (Буянова С.Н., Федорина С.И., Петракова С.А., Глебов Т.А., Клюшников И.Д., Брыляева А.Е. Пролапс тазовых органов у женщин молодого возраста //Российский вестник акушера-гинеколога. 2023. Т. 23, № 6-2. С. 142-148.) doi: 10.17116/rosakush202323062142
7. Erema VV, Buyanova SN, Mgeliashvili MV, Petrakova SA, Puchkova NV, Yudina NV, Glebov TA. Mesh-associated complications in the correction of pelvic organ prolapse and stress urinary incontinence. Russian Bulletin of Obstetrician-Gynecologist. 2021; 21(3): 74 78. Russian (Ерема В.В., Буянова С.Н., Мгелиашвили М.В., Петракова С.А., Пучкова Н.В., Юдина Н.В., Глебов Т.А. Mesh-ассоциированные осложнения при коррекции пролапса тазовых органов и стрессовой формы недержания мочи //Российский вестник акушера-гинеколога. 2021. Т. 21, № 3. С. 74 78.) doi: 10.17116/rosakush20212103174
8. Motamedi M, Carter SM, Degeling C. Women's Experiences of and Perspectives on Transvaginal Mesh Surgery for Stress Urine Incontinency and Pelvic Organ Prolapse: A Qualitative Systematic Review. Patient. 2022; 15(2): 157-169. doi: 10.1007/s40271-021-00547-7
9. Altman D, Rogers RG, Yin L, Tamussino K, Ye W, Iglesia CB. Cancer Risk After Midurethral Sling Surgery Using Polypropylene Mesh. Obstet Gynecol. 2018; 131(3): 469-474. doi: 10.1097/AOG.0000000000002496
10. Welk B, Al-Hothi H, Winick-Ng J. Removal or Revision of Vaginal Mesh Used for the Treatment of Stress Urinary Incontinence. JAMA Surg. 2015; 150(12): 1167-75. doi: 10.1001/jamasurg.2015.2590
11. Trabuco EC, Linder BJ, Klingele CJ, Blandon RE, Occhino JA, Weaver AL, et al. Two-Year Results of Burch Compared With Midurethral Sling With Sacrocolpopexy: A Randomized Controlled Trial. Obstet Gynecol. 2018; 131(1): 31-38. doi: 10.1097/AOG.0000000000002415
12. Ford AA, Rogerson L, Cody JD, Aluko P, Ogah JA. Mid-urethral sling operations for stress urinary incontinence in women. Cochrane Database Syst Rev. 2017; 7(7): CD006375. doi: 10.1002/14651858.CD006375.pub4
13. Nygaard I, Brubaker L, Zyczynski HM, Cundiff G, Richter H, Gantz M, et al. Long-term outcomes following abdominal sacrocolpopexy for pelvic organ prolapse. JAMA. 2013; 309(19): 2016-2024. Erratum in: JAMA. 2013; 310(10): 1076. doi: 10.1001/jama.2013.4919
14. Gurol-Urganci I, Geary RS, Mamza JB, Duckett J, El-Hamamsy D, Dolan L, et al. Long-term Rate of Mesh Sling Removal Following Midurethral Mesh Sling Insertion Among Women With Stress Urinary Incontinence. JAMA. 2018; 320(16): 1659-1669. doi: 10.1001/jama.2018.14997
15. Kupriyanov YuA, Gvozdev MYu, Kasyan GR, Pushkar DYu. Modern methods of urinary incontinence treatment: loop operations and minislings (part 1). Urology Herald. 2014; (1): 26-40. Russian (Куприянов Ю.А., Гвоздев М.Ю., Касян Г.Р., Пушкарь Д.Ю. Современные методы лечения недержания мочи: петлевые операции и минислинги (часть 1) //Вестник урологии. 2014. № 1. С. 26-40.) doi: 10.21886/2308-6424-2014-0-1-26-40
16. Wu YM, Welk B. Revisiting current treatment options for stress urinary incontinence and pelvic organ prolapse: a contemporary literature review. Res Rep Urol. 2019; 11: 179-188. doi: 10.2147/RRU.S191555