The Management And Outcomes Of Urethral Complications Of Mid Urethral Tapes For Stress Urinary Incontinence
BAUS ePoster online library. Toia B. 06/25/19; 259567; P7-3
Bogdan Toia
Bogdan Toia
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Abstract
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INTRODUCTION

Urethral complications of mid-urethral tapes (extrusion, fistula or loss) are extremely rare and the functional outcomes of their treatment relatively unknown. We examined the causes, presentations, treatment and outcomes of urethral complications of MUT. 

Patients
A retrospective analysis of a prospectively acquired database of patients having surgical management of urethral complications of MUT between 2008−2018 was performed.

RESULTS

35 patients of median age 54(33−82) years were identified, with the median time between tape insertion to removal of 5(1−15) years.
Pre−operative urodynamics showed SUI in 18/35 (51%), DO wet in 4/35 (11%), and DO dry in 4/35 (11%). 26/35 (74%) had repeat VUDS assessment; 21/26 (81%) had recurrent/persistent SUI, 5/26 (19%) had recurrent/persistent mixed urinary incontinence (MUI) and 5 (19%) had DO dry. 
20/34 (59%) went on to have further SUI surgery with cure or improvement in 15/20 (75%). 13 women had rectus fascial sling -9 are dry or improved. 5 had colposuspension -4 are dry or improved. 1 had Bulkamid injection and 1 had bladder artificial urinary sphincter – both are dry.

Conclusions
Vaginal removal of mid urethral tape, urethral repair and modified Martius labial fat pad (MlFP) interposition results in resolution of pain and a useable urethra in 97%. SUI persists or recurs in 74%. 59% require further SUI surgery, which has a 75% success rate. It is important to counsel patients having surgery for tape related urethral complications accurately regarding functional outcomes and the need for further interventions. 
INTRODUCTION

Urethral complications of mid-urethral tapes (extrusion, fistula or loss) are extremely rare and the functional outcomes of their treatment relatively unknown. We examined the causes, presentations, treatment and outcomes of urethral complications of MUT. 

Patients
A retrospective analysis of a prospectively acquired database of patients having surgical management of urethral complications of MUT between 2008−2018 was performed.

RESULTS

35 patients of median age 54(33−82) years were identified, with the median time between tape insertion to removal of 5(1−15) years.
Pre−operative urodynamics showed SUI in 18/35 (51%), DO wet in 4/35 (11%), and DO dry in 4/35 (11%). 26/35 (74%) had repeat VUDS assessment; 21/26 (81%) had recurrent/persistent SUI, 5/26 (19%) had recurrent/persistent mixed urinary incontinence (MUI) and 5 (19%) had DO dry. 
20/34 (59%) went on to have further SUI surgery with cure or improvement in 15/20 (75%). 13 women had rectus fascial sling -9 are dry or improved. 5 had colposuspension -4 are dry or improved. 1 had Bulkamid injection and 1 had bladder artificial urinary sphincter – both are dry.

Conclusions
Vaginal removal of mid urethral tape, urethral repair and modified Martius labial fat pad (MlFP) interposition results in resolution of pain and a useable urethra in 97%. SUI persists or recurs in 74%. 59% require further SUI surgery, which has a 75% success rate. It is important to counsel patients having surgery for tape related urethral complications accurately regarding functional outcomes and the need for further interventions. 

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