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Abstract Objective To compare the functional (obstruction relieving) outcomes and complications of unilateral J‐cut division, partial and subtotal vaginal removal techniques were performed for mesh‐related urethral obstruction (MRUO) in females. Methods Patient review included demographics, a medical history and proforma with details of lower urinary tract symptoms (LUTS), physical and urodynamic findings, detailed surgical reports and follow‐up data. Variables were compared between the three groups. Results Out of 130 patients with sling revision surgery (SRS), 54 women underwent SRS for MRUO with a median follow‐up of 48 (17–96) months. Unilateral J‐cut division, partial and subtotal vaginal removal techniques were performed in 12, 31 and 11 patients with a median duration of surgery of 30 (25–34), 40 (35–56) and 60 (60–70) minutes, respectively (p = 0.001). Statistically significant increase in median maximum free urine flow rate and decrease in median post‐void residual urine volume were found after SRS in the three groups, while de novo stress urinary incontinence (SUI) developed in 10%, 44% and 60% of the patients in the unilateral J‐cut division, partial and subtotal removal groups, respectively (p = 0.007). Conclusions The unilateral J‐cut division technique was as effective as the partial and subtotal vaginal removal techniques in relieving MRUO with a shorter duration of surgery time (p = 0.001) and lower risk of de novo SUI (p = 0.007). Comparative studies with a larger number of patients are needed.

Introduction and hypothesis: The mid-urethral sling (MUS) is considered the gold standard for stress urinary incontinence (SUI). Nevertheless, this procedure is not excluded from postsurgical complications, which can be challenging for most clinicians. Hence, one of the main concerns about this procedure is late postoperative voiding dysfunction (LDS), defined as obstructive symptoms 6 weeks after surgery. Primary medical management regularly includes expectant management and rehabilitation, including the mid-urethral cut sling (MUCS) as an alternative when it fails. This video provides an anatomical illustration and detailed description of the surgical steps of the J-cut of the lateral sling. Materials and methods: We set up a step-by-step surgical process and provided some advice for MUCS in a video; this material included how to position the sling, dissect, isolate the synthetic material, release adhesions and make a lateral cut of the MUS. Additionally, a case series of 30 patients from our institution is described to confirm the effectiveness of MUCS to manage delayed voiding dysfunction syndrome. Results: MUCS in LDS was beneficial for our patients. Obstructive symptoms improved clinically from 75% to 100%, and urgency-related symptoms decreased from 57.9% to 26.3%, evidencing 20% SUI post-MUCS surgery. Conclusions: The lateral cut of the mid-urethral tape should be considered a surgical alternative for the resolution of post-sling late voiding dysfunction syndrome in patients who do not improve with expectant management. [ABSTRACT FROM AUTHOR]

Objective: To compare the functional (obstruction relieving) outcomes and complications of unilateral J-cut division, partial and subtotal vaginal removal techniques were performed for mesh-related urethral obstruction (MRUO) in females., Methods: Patient review included demographics, a medical history and proforma with details of lower urinary tract symptoms (LUTS), physical and urodynamic findings, detailed surgical reports and follow-up data. Variables were compared between the three groups., Results: Out of 130 patients with sling revision surgery (SRS), 54 women underwent SRS for MRUO with a median follow-up of 48 (17-96) months. Unilateral J-cut division, partial and subtotal vaginal removal techniques were performed in 12, 31 and 11 patients with a median duration of surgery of 30 (25-34), 40 (35-56) and 60 (60-70) minutes, respectively ( p  = 0.001). Statistically significant increase in median maximum free urine flow rate and decrease in median post-void residual urine volume were found after SRS in the three groups, while de novo stress urinary incontinence (SUI) developed in 10%, 44% and 60% of the patients in the unilateral J-cut division, partial and subtotal removal groups, respectively ( p  = 0.007)., Conclusions: The unilateral J-cut division technique was as effective as the partial and subtotal vaginal removal techniques in relieving MRUO with a shorter duration of surgery time ( p  = 0.001) and lower risk of de novo SUI ( p  = 0.007). Comparative studies with a larger number of patients are needed., Competing Interests: There is no conflict of interest., (© 2024 The Authors. BJUI Compass published by John Wiley & Sons Ltd on behalf of BJU International Company.)

Objectives: To review various erroneous diagnoses assigned to symptomatic women after MUS incision, and report our outcomes after MUS excision in these women. Materials and Methods: Following IRB approval, a retrospective review of a prospectively collected MUS removal database was performed for non-neurogenic women who presented with continued LUTS despite a prior sling incision. Data reviewed by a neutral investigator not involved in patient care included demographics, presenting symptomatology, and outcomes after sub-urethral sling excision. Results: From 2006-2015, 18 patients were identified. Mean age was 55 + 12 years. Median time from initial placement to sling incision was 12 (range 1-108) months. Following sling incision, residual LUTS were treated with various therapies but without LUTS resolution. Indications for sling excision were obstruction (3), obstruction and pain (2), persistent vaginal pain/dyspareunia (9), recurrent vaginal exposure/dyspareunia (2), worsening urgency incontinence (1) and mixed urinary incontinence (1). Median time from sling incision to sling excision was 55 (range 5-146) months. Median follow-up after MUS excision was 12 months (range 6-45 months). Obstruction (5) and exposure (2) were all cured. Vaginal pain and dyspareunia improved in 8 of 11 women and UUI improved in one. Three women had persistent SUI and 1 developed recurrent SUI. Two women were treated satisfactorily with bulking agents, one with fascial sling and one with bulking agent followed by a fascial sling. Conclusions: Sling incision may not always resolve LUTS. In a subset of women, sling excision may eventually be needed, with variable outcomes.

Objectives: To review various erroneous diagnoses assigned to symptomatic women after MUS incision, and report our outcomes after MUS excision in these women. Materials and Methods: Following IRB approval, a retrospective review of a prospectively collected MUS removal database was performed for non-neurogenic women who presented with continued LUTS despite a prior sling incision. Data reviewed by a neutral investigator not involved in patient care included demographics, presenting symptomatology, and outcomes after sub-urethral sling excision. Results: From 2006-2015, 18 patients were identified. Mean age was 55 + 12 years. Median time from initial placement to sling incision was 12 (range 1-108) months. Following sling incision, residual LUTS were treated with various therapies but without LUTS resolution. Indications for sling excision were obstruction (3), obstruction and pain (2), persistent vaginal pain/dyspareunia (9), recurrent vaginal exposure/dyspareunia (2), worsening urgency incontinence (1) and mixed urinary incontinence (1). Median time from sling incision to sling excision was 55 (range 5-146) months. Median follow-up after MUS excision was 12 months (range 6-45 months). Obstruction (5) and exposure (2) were all cured. Vaginal pain and dyspareunia improved in 8 of 11 women and UUI improved in one. Three women had persistent SUI and 1 developed recurrent SUI. Two women were treated satisfactorily with bulking agents, one with fascial sling and one with bulking agent followed by a fascial sling. Conclusions: Sling incision may not always resolve LUTS. In a subset of women, sling excision may eventually be needed, with variable outcomes. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: Controversy continues over the effectiveness of sling incision, which is the most common operative approach to treating complications following suburethral sling insertion. This retrospective analysis assessed the indications for sling incision and patient outcomes regarding resolution of complications and stress urinary incontinence. Methods: A review was conducted of the medical records of women who underwent sling incision between 2003 and 2010. Data such as surgical indications, ultrasound findings and medical outcomes were extracted from 198 records, and descriptive and inferential statistical methods of analysis were used. Results: In the 198 patients eligible for study inclusion, the primary reasons for sling incision were overactive bladder (68 %), voiding dysfunction (61 %), and recurrent urinary tract infections (53 %). Additional complications included dyspareunia (18 %), chronic pelvic pain (17 %), and sling exposure (15 %). Sling incision led to immediate postoperative cure of voiding dysfunction in 97 % of patients. Cure rates for overactive bladder and dyspareunia were 60 % and 94 % respectively. Chronic pelvic pain was resolved in 82 % of cases and all cases of sling exposure were cured. Eighty-five (61 %) of the 140 patients who were continent before sling incision developed recurrent stress urinary incontinence (SUI) postoperatively. Conclusions: These findings indicate that sling incision can be highly successful in improving voiding dysfunction and dyspareunia, and moderately successful in curing overactive bladder and chronic pain. However, SUI may recur in more than 60 % of the patients undergoing sling incision. Consequently, patients being considered for a sling incision procedure should be informed about this possible complication. [ABSTRACT FROM AUTHOR]

Obstructed voiding is a well recognized complication following a suburethral sling procedure. Current methods of transvaginal and transabdominal urethrolysis have had variable success rates in relieving the obstruction, and do not restabilize the urethra to prevent potential postoperative stress incontinence. We report on a procedure used in 4 cases which addresses both of these issues. All patients had persistent urinary retention beyond 8 weeks after a suburethral sling procedure. An oupatient procedure consisting of sling incision and associated tissue interposition (vaginal wall in three cases and fascia lata in one) was successful in relieving the obstruction. Continence status was maintained in 3 of the 4 patients. There were no major complications of this outpatient procedure. [ABSTRACT FROM AUTHOR]