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Second-Line Surgical Management After Midurethral Sling Failure

김덕윤|김연주|권준범
대한배뇨장애요실금학회 (Korean Continence Society)|2021.06|International Neurourology Journal|제25권 제2호|pp. 111-118|DOI 10.5213/inj.2040278.139

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참고문헌

키워드

RecurrenceUrinary incontinenceSuburethral sling

초록

Currently, the midurethral sling (MUS) is widely used as a standard treatment in patients with stress urinary incontinence (SUI). Several studies have reported the failure rate of MUS to be approximately 5%–20%. In general, sling failure can be defined as persistent SUI after surgery or a temporary improvement in incontinence followed by recurrence. Failure is also often considered to include cases requiring secondary surgery due to mesh exposure, postoperative voiding difficulty, de novo urgency/ urge incontinence, and severe postoperative pain. Because of the lack of large-scale, high-quality research on this topic, no clear guidelines exist for second-line management. To date, transurethral bulking agent injections, tape shortening, repeat MUS, pubovaginal sling (PVS) using autologous fascia, and Burch colposuspension are available options for second-line surgery. Repeat MUS is the most widely used second-line surgical method at present. Bulking agent injections have lower durability and efficacy than other treatments. Tape shortening demonstrates a relatively low success rate, but comparable outcomes if the period from first treatment to relapse is short. In patients with intrinsic sphincter deficiency, PVS and retropubic (RP) MUS can be considered first as second-line management because of their higher success rate than other treatments. When revision or reoperation is required due to prior mesh-related complications, PVS or colposuspension, which is performed without a synthetic mesh, is appropriate for second-line surgery. For patients with detrusor underactivity, a readjustable sling can be a better option because of the high risk of postoperative voiding dysfunction in PVS or RP slings.

Abstract

Currently, the midurethral sling (MUS) is widely used as a standard treatment in patients with stress urinary incontinence (SUI). Several studies have reported the failure rate of MUS to be approximately 5%–20%. In general, sling failure can be defined as persistent SUI after surgery or a temporary improvement in incontinence followed by recurrence. Failure is also often considered to include cases requiring secondary surgery due to mesh exposure, postoperative voiding difficulty, de novo urgency/ urge incontinence, and severe postoperative pain. Because of the lack of large-scale, high-quality research on this topic, no clear guidelines exist for second-line management. To date, transurethral bulking agent injections, tape shortening, repeat MUS, pubovaginal sling (PVS) using autologous fascia, and Burch colposuspension are available options for second-line surgery. Repeat MUS is the most widely used second-line surgical method at present. Bulking agent injections have lower durability and efficacy than other treatments. Tape shortening demonstrates a relatively low success rate, but comparable outcomes if the period from first treatment to relapse is short. In patients with intrinsic sphincter deficiency, PVS and retropubic (RP) MUS can be considered first as second-line management because of their higher success rate than other treatments. When revision or reoperation is required due to prior mesh-related complications, PVS or colposuspension, which is performed without a synthetic mesh, is appropriate for second-line surgery. For patients with detrusor underactivity, a readjustable sling can be a better option because of the high risk of postoperative voiding dysfunction in PVS or RP slings.

참고문헌 (70)

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관련 논문AI추천

Current Overview of Surgical Options for Female Stress Urinary Incontinence김세환, 김아람, 김형곤대한배뇨장애요실금학회 · International Neurourology Journal2020 · 제24권 제3호Tape Shortening for Recurrent Stress Urinary Incontinence After Transobturator Tape Sling: 3-Year Follow-up Results김설, 고준성, 김준철, 김효신, 손준호대한배뇨장애요실금학회 · International Neurourology Journal2010 · 제14권 제3호Twenty-Five Years of the Midurethral Sling: Lessons LearnedJinna Yao, Vincent Tse대한배뇨장애요실금학회 · International Neurourology Journal2022 · 제26권 제2호Comparison of the Long-term Treatment Outcome Between Pubovaginal and Transobturator Suburethral Sling for Stress Urinary Incontinence in WomenHann-Chorng Kuo, Sheng-Fu Chen, Yi-Hsuan Wu, Yuan-Hong Jiang대한배뇨장애요실금학회 · International Neurourology Journal2025 · 제29권 제4호Modified Distal Urethral Polypropylene Sling (Canal Transobturator Tape) Procedure: Efficacy for Persistent Stress Urinary Incontinence After a Conventional Midurethral Sling Procedure김계환, 김광택, 김창희, 김태범, 오진규, 윤상진대한배뇨장애요실금학회 · International Neurourology Journal2013 · 제17권 제1호Long-term Outcomes of Tension-free Vaginal Tape Procedure for Treatment of Female Stress Urinary Incontinence with Intrinsic Sphincter Deficiency김대현, 김형곤, 노용수, 박형근, 백성현, 추관엽대한배뇨장애요실금학회 · International Neurourology Journal2012 · 제16권 제1호

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