Document Detail


Revisions of Mid Urethral Slings Can Be Accomplished in the Office.
MedLine Citation:
PMID:  22591958     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
PURPOSE: Mid urethral slings occasionally require revision for obstructive voiding symptoms or vaginal extrusion. Our approach has been to offer revision in office or resection done under local anesthesia when the patient is agreeable and deemed an appropriate candidate. The results and complications of these procedures are presented. MATERIALS AND METHODS: We retrospectively reviewed the charts of patients from January 2003 to October 2010 to determine the subset with mid urethral sling insertion who subsequently underwent revision in the office or operating room, as identified through the Northwestern Medical Enterprise Data Warehouse. The CPT code for female sling insertion (57288) or revision/removal (57287) was used. RESULTS: A total of 41 revisions were performed in 28 of the 118 patients (23.7%) who underwent synthetic sling insertion. Reasons for adjustment were an intravesical sling (1 operating room case), extruded vaginal mesh (7 operating room and 19 office) and obstructive voiding symptoms (7 operating room and 7 office). Obstructive voiding symptoms in 6 of 7 operating room and 6 of 7 office patients improved immediately after sling release. There were no complications in either group but 3 office patients required repeat revision in the operating room due to inability to tolerate the procedure in 2 and to nonrelief of symptoms in 1. A total of 13 operating room adjustments were made according to surgeon preference while 2 patients elected the operating room, although adjustment in office was offered. CONCLUSIONS: Sling adjustment due to vaginal mesh extrusion or obstructive voiding symptoms can be successfully performed in the office with good result. When greater adjustment is needed, the operating room may be preferable. Surgeons should make these decisions based on their comfort level and patient preference.
Authors:
Alyssa Greiman; Stephanie Kielb
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-5-15
Journal Detail:
Title:  The Journal of urology     Volume:  -     ISSN:  1527-3792     ISO Abbreviation:  -     Publication Date:  2012 May 
Date Detail:
Created Date:  2012-5-17     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376374     Medline TA:  J Urol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
Affiliation:
Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
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