[Guidelines for the surgical treatment of female urinary stress incontinence in women using the suburethral sling]

Abstract

The complications of suburethral slings are rare but varied. The operative complications result most often from errors in surgical technique. Intraoperative cystoscopy is required when implanting a retropubic sling to diagnose vesical transfixion intraoperatively. Functional complications are the most frequent. They require a true diagnostic strategy before proposing treatment adapted to the patient. The first examination should be an endoscopic urethrovesical exploration to eliminate vesicourethral transfixion by the suburethral slings. Acute postoperative retention most often stems from surgical relaxation of the suburethral slings during the immediate postoperative period. Dysuria is more easily reversed if it is treated early with resection or ablation of the suburethral slings. De novo urge incontinence has many etiologies : infection, urethral obstruction, more rarely cystocele, and idiopathic causes. With recurrent stress incontinence after suburethral slings, management will depend on anamnesis, as well as the clinical and urodynamic workups. The treatment could involve the sling (second suburethral sling, kinking of the suburethral sling); however, another therapeutic alternative will have to be suggested relatively early (artificial sphincter, ACT balloons, etc.). The recommended use of the large-mesh knitted monofilament polypropylene suburethral sling has considerably reduced the risk of infectious complications related to the prosthetic material. In case of vaginal erosion, prosthesis infection must be eliminated, which requires removing the sling. Simple erosion can be treated with partial resection of the exposed sling and vaginal suture. Many nonabsorbant palliative treatments have been reported, often with small series. They can be grouped into three types: extra-urethral occlusive devices, intra-urethral obstructive devices, and intravaginal support devices. The use of a pessary or other vaginal devices can be proposed, in particular with associated prolapse, which can be used when leakage is very occasional (sport, etc.) or in women who cannot have any other treatment.