Urinary complications in sub-urethral sling procedures
Résumé
INTRODUCTION: Urinary complications following sub urethral sling procedures are common, and management of these complications continue to be discussed. METHODS: The literature available on Medline/PubMed, relating to urinary complications associated with suburethral sling procedures, was reviewed. RESULTS: Bladder perforation, which occurs with an incidence of 5.7% in tension-free vaginal tape procedure, requires repositioning of the sling, but does not cause any increase in postoperative morbidity. The trans-obturator approach appears to decrease this risk. Urethral perforation, which is uncommon (0.4-1%), is a contraindication to maintenance of the sling. Bladder erosion is rare, requiring resection of the mesh with a combined abdominal and cystoscopic approach. Urethral mesh erosion (0.07% to 1.5%) also requires surgical sling removal, but few patients remain continent because this removal requires a large urethrolysis (recurrence rate of incontinence is 66% following removal of the sling). Bladder outlet obstruction occurs frequently after sub-urethral procedures. When complete obstruction is clinically evident 2 days after a sub-urethral sling procedure, immediate reintervention is performed with a rapid return to normal voiding. Recurrence rate of stress incontinence is less than 30% following reintervention.