Dyspareunia associated with paraurethral banding in the transobturator sling.

OBJECTIVE: We sought to compare the development of paraurethral banding and subsequent dyspareunia in women undergoing either a transobturator (TO) or retropubic (RP) sling. STUDY DESIGN: We conducted a retrospective cohort study comparing women treated with either a TO or RP sling during a 10-month period. RESULTS: A total of 25 TO sling patients and 28 RP sling patients were compared in the study. Paraurethral banding was observed in 13/25 (52%) of the TO group compared with none in the RP group (P<.001). Although no difference was noted in overall female sexual function index scores, de novo internal dyspareunia was reported in 4/17 (24%) of the TO group and none in the RP group (P=.04). Paraurethral banding was observed in all patients reporting dyspareunia. CONCLUSION: We have identified paraurethral banding as a previously unreported complication of the TO sling. Surgeons should be aware of paraurethral banding and subsequent internal dyspareunia as a potential complication.

Bowel perforation during retropubic sling procedure.

BACKGROUND: Bowel perforation is a rare complication of tension-free vaginal tape (TVT)-type sling procedures and has been reported in patients with a previous history of abdominal or pelvic surgery. CASE: A 77-year-old woman with no prior history of abdominal or pelvic surgery underwent elective surgery for pelvic organ prolapse with a vaginal vault colpocleisis and suburethral sling. On postoperative day 2, a computed tomography scan performed for suprapubic discomfort showed an enterocutaneous fistula, which was treated surgically. CONCLUSION: Bowel perforation is a complication of TVT-type slings in patients with or without prior abdominal or pelvic surgery. High clinical suspicion, prompt identification, and surgical intervention allowed for a favorable outcome in this case.

Vesico-uterine fistula after endometrial ablation in a woman with prior cesarean deliveries.

BACKGROUND: Impedance-controlled endometrial ablation is a common procedure for menorrhagia in premenopausal women with relatively few contraindications. CASE: A 54-year-old woman with an obstetric history significant for three prior low transverse cesarean deliveries reported a constant drip of urine from the vagina beginning approximately 2 weeks after impedance-controlled endometrial ablation for menorrhagia. Evaluation confirmed a vesico-uterine fistula in the area of the prior cesarean delivery scars. The patient underwent a successful repair of the fistula using the abdominal approach. CONCLUSION: Vesico-uterine fistula may be associated with impedance-controlled endometrial ablation in women with prior low transverse cesarean deliveries.

Urodynamic changes after tension-free sling procedures: Mycromesh-Plus vs TVT sling.

Assortments of suburethral sling procedures have become increasingly important in the treatment of stress urinary incontinence (SUI). This study compared a consecutive series of patients undergoing two types of no-tension, midurethral sling procedures: a traditional pubovaginal technique and graft (modified polytetrafluoroethylene graft; Mycromesh-Plus [MMP]) and the more recently introduced tension-free vaginal tape (TVT) sling. We observed for differences in success rates, urodynamic parameters, and complications of the two procedures. One group received a MMP sling, which was placed at the midurethra without tension. The other group underwent a minimally invasive TVT sling. Multichannel urodynamic studies were performed pre- and postoperatively. Cure rates for SUI were similar for the two groups (95 vs 95%). Urgency and urge incontinence symptoms improved substantially in both groups. Comparison of pre- and postoperative urodynamic indices demonstrated no differences in changes in average functional urethral lengths, changes in maximum urethral closure pressures, or improvement in pressure transmission ratios. Both groups showed a decrease in urethral mobility postoperatively. However, the TVT group demonstrated a lesser degree of change. While the TVT group did spontaneously void earlier than the MMP group (5.7 vs 9.7 days, p < 0.05), this did not result in significantly different postvoid residual volumes (71 vs 101 mL). Complications, including need for self-catheterization and sling revision or removal, and urinary tract infections also were fewer in the TVT group. This study demonstrated that the TVT sling affords an equivalent cure of SUI with similar urodynamic changes but significantly fewer complications than the more traditional MMP sling.

Herpes zoster-associated acute urinary retention: a case report.

An 87-year-old woman presents with a 4-week history of urinary incontinence during which she had been treated for disseminated herpes zoster virus (HZV). On physical exam painful vesicles involving the entire vulvar region with mainly right sacral distribution were found. A catheterized volume exceeded 600 ml of retained urine after the patient failed to void spontaneously. Multichannel voiding-pressure urodynamic studies revealed an acontractile neurogenic bladder with overflow incontinence. The patient was discharged on a conservative regimen with arrangement for visiting nurse services to perform intermittent self-catheterization twice daily. Urodynamic testing was repeated 10 weeks after initial symptoms. During voiding cystometry a biphasic increase in detrusor pressure of 15 cm H2O was observed with no increase in abdominal pressure. The patient emptied 400 ml with a postvoid residual of 300 ml. Recovery from HZV-associated bladder emptying dysfunction can be achieved usually through conservative management, including intermittent self-catheterization. Complete recovery time ranges from 4 to 10 weeks.

Voiding function after a modified no-tension pubovaginal sling.

Voiding dysfunction following sling procedures for correction of genuine stress urinary incontinence (GSI) is a frequently reported complication. This study sought to determine if voiding dysfunction could be reduced by eliminating sling tension against the urethra. Participants were diagnosed with GSI and randomized to one of two surgical groups. One received a conventional suburethral sling and the other received a modified sling placed at the mid-urethra without tension. Voiding trials after surgery monitored for voiding dysfunction. Multichannel urodynamic studies were performed pre- and post-operatively. Cure rates for GSI were similar for the two groups (91.7 vs. 88.5%). The 27 patients in the modified group voided an average of 5 days earlier than the 21 patients in the conventional group. Conventional group patients were more likely to have urinary retention (125 vs. 49 cc, p=0.03). The modified group had a lesser change in average closure pressure following surgery. Results suggested a higher increase in urethral resistance in the conventional group (0.72 vs. 1.88 cm H2O ml(-2) sec2). No differences were seen in symptomatic urinary urgency or urge incontinence following surgery. This study demonstrated a no-tension sling at the mid-urethra to afford equivalent cure of GSI with significant reduction of voiding dysfunction.