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Review
. 2017 Sep-Oct;43(5):822-834.
doi: 10.1590/S1677-5538.IBJU.2016.0250.

Update on complications of synthetic suburethral slings

Cristiano Mendes Gomes  1 , Fabrício Leite Carvalho  1 , Carlos Henrique Suzuki Bellucci  1 , Thiago Souto Hemerly  1 , Fábio Baracat  1 , Jose de Bessa Jr  1 , Miguel Srougi  1 , Homero Bruschini  1
Affiliations
Review

Update on complications of synthetic suburethral slings

Cristiano Mendes Gomes et al. Int Braz J Urol. 2017 Sep-Oct.

Abstract

Synthetic suburethral slings have become the most widely used technique for the surgical treatment of stress urinary incontinence. Despite its high success rates, significant complications have been reported including bleeding, urethral or bladder injury, urethral or bladder mesh erosion, intestinal perforation, vaginal extrusion of mesh, urinary tract infection, pain, urinary urgency and bladder outlet obstruction. Recent warnings from important regulatory agencies worldwide concerning safety issues of the use of mesh for urogynecological reconstruction have had a strong impact on patients as well as surgeons and manufacturers. In this paper, we reviewed the literature regarding surgical morbidity associated with synthetic suburethral slings.

Keywords: Polypropylenes; Postoperative Complications; Urinary Incontinence.

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Conflict of interest statement

Conflict of interest: None declared.

Figures

Figure 1
Figure 1. Haematoma of the right thigh (arrow) on post-operative day 3 of a transobturator SSS, with spontaneous resolution.
Figure 2
Figure 2. CT scan in the first postoperative day following a retropubic SSS demonstrates large pelvic hematoma (arrow) compressing the bladder laterally.
Figure 3
Figure 3. Cystoscopic view of sling mesh (arrow) in the bladder after a retropubic sling surgery.
Figure 4a
Figure 4a. Pelvic CT scan shows calcified sling tape (arrow) eroding the bladder wall at the left side 2 years after a retropubic SSS.
Figure 4b
Figure 4b. Mesh erosion in the urethra found in urethrocystoscopy two years after SSS (arrow).
Figure 5
Figure 5. Endoscopic treatment of mesh erosion in the bladder using laparoscopic scissors (arrow).
Figure 6
Figure 6. Vaginal extrusion (arrow) of mesh at the left anterolateral vaginal wall.
Figure 7
Figure 7. Transvaginal removal of an infected and extruded sling mesh (arrow).
Figure 8
Figure 8. Large subcutaneous abscess (arrow) after transobturatory SSS treated with ultrasound guided puncture.
Figure 9a
Figure 9a. Urodynamics findings of a patient with BOO secondary to a retropubic SSS, showing high detrusor pressures (short arrow) and low maximum flow rate (long arrow).
Figure 9b
Figure 9b. Sling incision (arrow) in the same patient after vaginal incision.
Figure 9c
Figure 9c. Postoperative urodynamics demonstrates resolution of the BOO, with low detrusor pressures (PdetQmax 8cm H20 - short arrow) and good flow (Qmax 42mL/s - long arrow).
See this image and copyright information in PMC

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