Management of urological complications of mid urethral tape within a centralised centre: analysis of surgical management 2016-2018
BAUS ePoster online library. Dooher M. Jun 27, 2018; 211392; P10-4
Ms. Maeve Dooher
Ms. Maeve Dooher
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Abstract
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Introduction: The Independent Review of transvaginal mesh implants was set up by the Scottish government in 2015 to assess the evidence relating to surgery using synthetic mesh implants for the treatment of stress urinary incontinence (SUI) and pelvic organ prolapse (POP). The final review in 2017 recommended the management Mid Urethral Sling (MUS) complications be centralised as a result.

Methods: A review and analysis logbooks, theatre log and multidisciplinary team (MDT) discussion identified patients who underwent surgical management of International Continence Society(ICS)/International Urogynaecological Association (IUGA) category 4 complications (urinary tract).

Results: From January 2016 to January 2018, 20 patients with category 4 complications underwent surgical management. All patients presented within the T4 category (over 12 months) ranging from 2000 to 2012 with 90% (18/20) being inserted by gynaecologists compared with 10% (2/20) of urologists. 70% (14/20) of complications were urethral perforations with 86% (12/14) being treated with fistula repair and the remaining cases with LASER (with 3 of the surgical cases haven previously undergone a total of 10 LASER procedures previously). The remaining 30% (6/20) were bladder perforations with 66.6% (4/6) being surgically repaired and 33.3% (2/6) undergoing LASER. Post-operatively, 15% (3/20) patients were completely dry and did not require any further intervention, 60% of patients (12/20) had mild - moderate OAB incontinence treated by physiotherapy, 10% (2/20) have undergo further anti-incontinence surgery and 15% (3/20) are awaiting review.

Conclusion: MUS insertion complications should be classified appropriately and managed in a dedicated, centralised reconstruction unit to ensure long-term satisfactory outcomes.
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