Diagnosis and treatment of synthetic mid-urethral sling complications
Background and Objective:: Synthetic Mid-Urethral Slings (SMUS) have been widely used with benefit to many women. Complications arise in a small proportion, occurring acutely in the perioperative stage, post-operatively and in a delayed fashion many years after implantation. Clinical trials provide...
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Elsevier
2025-06-01
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| Series: | Continence |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772973725000177 |
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| author | Helen E. O’Connell Christopher K. Harding Gaurav Khatri Phyllis Glanc Eric Bautrant Sarah Love-Jones Karen Ward Henry H. Yao Ventia Hoe Charlotte Korte Nicolle Germano Sanjeevan Kalavampara Sherif Mourad Hashim Hashim |
| author_facet | Helen E. O’Connell Christopher K. Harding Gaurav Khatri Phyllis Glanc Eric Bautrant Sarah Love-Jones Karen Ward Henry H. Yao Ventia Hoe Charlotte Korte Nicolle Germano Sanjeevan Kalavampara Sherif Mourad Hashim Hashim |
| author_sort | Helen E. O’Connell |
| collection | DOAJ |
| description | Background and Objective:: Synthetic Mid-Urethral Slings (SMUS) have been widely used with benefit to many women. Complications arise in a small proportion, occurring acutely in the perioperative stage, post-operatively and in a delayed fashion many years after implantation. Clinical trials provide data on selected patients who are as homogeneous as possible. Real world studies rarely provide detail on the denominator population from which the sample originates. Mature clinical quality registries (CQR) provide long term data on a non selected population who have undergone a procedure for a given condition. Near complete case ascertainment is the goal and there are many examples in other clinical areas.Due to the serious and potentially life changing nature of some of the complications that may arise following SMUS, health agencies instigated action on behalf of patients to promote improvements in care. Methods and Limitations:: The International Continence Society (ICS) assembled a multidisciplinary working group to forge this guidance. The working group includes 2 consumer advocates and relevant medical expertise. The management of complications following SMUS placement is discussed and algorithms are provided for each of the common complications of SMUS. The recommendations are based on an expert consensus derived from experience and limited data from a multiple narrative and systematic reviews of the literature. Due to a retrospective design, low cohort numbers, short follow-up and inconsistent definitions, all the studies were at high risk of bias (Figure 1). Key Findings and Conclusions:: This overview of SMUS complications commissioned by the ICS aims to provide background literature and algorithms for management of common problems that may present, though it is not exhaustive. Problems such as recurrent urine infection and overactive bladder may have their root cause in an obstructive SMUS. The temporal link between sling implantation and onset of symptoms is not always evident and patients are not always aware that an SMUS was implanted as part of a pelvic floor procedure. Clinicians need to be assiduous in their history taking and physical examination to determine the likely root cause using imaging or other tests judiciously. Multi-disciplinary teams (MDT) are required particularly where chronic pain has developed |
| format | Article |
| id | doaj-art-223aca5f288f41619a8cfb2e9af86a2f |
| institution | DOAJ |
| issn | 2772-9737 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Continence |
| spelling | doaj-art-223aca5f288f41619a8cfb2e9af86a2f2025-08-20T03:21:46ZengElsevierContinence2772-97372025-06-011410176010.1016/j.cont.2025.101760Diagnosis and treatment of synthetic mid-urethral sling complicationsHelen E. O’Connell0Christopher K. Harding1Gaurav Khatri2Phyllis Glanc3Eric Bautrant4Sarah Love-Jones5Karen Ward6Henry H. Yao7Ventia Hoe8Charlotte Korte9Nicolle Germano10Sanjeevan Kalavampara11Sherif Mourad12Hashim Hashim13Department of Surgery, University of Melbourne, Melbourne, Australia; Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia; Corresponding author at: Department of Surgery, University of Melbourne, Melbourne, Australia.Translational and Clinical Research Institute, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle University, United KingdomDepartment of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USADepartment of Medical Imaging, Sunnybrook Research Institute, Sunnybrook Health Science Center, University of Toronto, Toronto, CanadaAix en Provence Womens Health Research Centre, Pelvic and Périnéal Pain Unit, Hôpital Saint-Joseph, Paris, FranceNorth Bristol NHS Trust, Southmead Hospital, Bristol, UKSaint Mary’s Hospital, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, UKDepartment of Surgery, University of Melbourne, Melbourne, Australia; Eastern Health Clinical School, Monash University, Melbourne, AustraliaDepartment of Surgery, University of Melbourne, Melbourne, AustraliaHealth Consumer Advocacy Alliance, New ZealandQueensland Pelvic Mesh Service, AustraliaAmrita Institute of Medical Sciences, Kochi, India Research Fellow in Functional Urology, IndiaAin Shams University, Cairo, Egypt, Katameya Clinic for Medical Services New Cairo, EgyptBristol Urological Institute & University of Bristol, Bristol, UKBackground and Objective:: Synthetic Mid-Urethral Slings (SMUS) have been widely used with benefit to many women. Complications arise in a small proportion, occurring acutely in the perioperative stage, post-operatively and in a delayed fashion many years after implantation. Clinical trials provide data on selected patients who are as homogeneous as possible. Real world studies rarely provide detail on the denominator population from which the sample originates. Mature clinical quality registries (CQR) provide long term data on a non selected population who have undergone a procedure for a given condition. Near complete case ascertainment is the goal and there are many examples in other clinical areas.Due to the serious and potentially life changing nature of some of the complications that may arise following SMUS, health agencies instigated action on behalf of patients to promote improvements in care. Methods and Limitations:: The International Continence Society (ICS) assembled a multidisciplinary working group to forge this guidance. The working group includes 2 consumer advocates and relevant medical expertise. The management of complications following SMUS placement is discussed and algorithms are provided for each of the common complications of SMUS. The recommendations are based on an expert consensus derived from experience and limited data from a multiple narrative and systematic reviews of the literature. Due to a retrospective design, low cohort numbers, short follow-up and inconsistent definitions, all the studies were at high risk of bias (Figure 1). Key Findings and Conclusions:: This overview of SMUS complications commissioned by the ICS aims to provide background literature and algorithms for management of common problems that may present, though it is not exhaustive. Problems such as recurrent urine infection and overactive bladder may have their root cause in an obstructive SMUS. The temporal link between sling implantation and onset of symptoms is not always evident and patients are not always aware that an SMUS was implanted as part of a pelvic floor procedure. Clinicians need to be assiduous in their history taking and physical examination to determine the likely root cause using imaging or other tests judiciously. Multi-disciplinary teams (MDT) are required particularly where chronic pain has developedhttp://www.sciencedirect.com/science/article/pii/S2772973725000177Mesh removalStress incontinenceSlingsMid-urethralSurgical complications |
| spellingShingle | Helen E. O’Connell Christopher K. Harding Gaurav Khatri Phyllis Glanc Eric Bautrant Sarah Love-Jones Karen Ward Henry H. Yao Ventia Hoe Charlotte Korte Nicolle Germano Sanjeevan Kalavampara Sherif Mourad Hashim Hashim Diagnosis and treatment of synthetic mid-urethral sling complications Continence Mesh removal Stress incontinence Slings Mid-urethral Surgical complications |
| title | Diagnosis and treatment of synthetic mid-urethral sling complications |
| title_full | Diagnosis and treatment of synthetic mid-urethral sling complications |
| title_fullStr | Diagnosis and treatment of synthetic mid-urethral sling complications |
| title_full_unstemmed | Diagnosis and treatment of synthetic mid-urethral sling complications |
| title_short | Diagnosis and treatment of synthetic mid-urethral sling complications |
| title_sort | diagnosis and treatment of synthetic mid urethral sling complications |
| topic | Mesh removal Stress incontinence Slings Mid-urethral Surgical complications |
| url | http://www.sciencedirect.com/science/article/pii/S2772973725000177 |
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