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Review Article • int j urol 43 (05) • Sep-Oct 2017 • https://doi.org/10.1590/S1677-5538.IBJU.2016.0250 copy

Update on complications of synthetic suburethral slings

Authorship SCIMAGO INSTITUTIONS RANKINGS

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:
Urinary Incontinence; Polypropylenes; Postoperative Complications

Complication	Retropubic	Transobturatory
Bleeding	0.7 to 8% ⁽²⁷27. Fischer A, Fink T, Zachmann S, Eickenbusch U. Comparison of retropubic and outside-in transoburator sling systems for the cure of female genuine stress urinary incontinence. Eur Urol. 2005;48:799-804.^,²⁹29. Porena M, Costantini E, Frea B, Giannantoni A, Ranzoni S, Mearini L, et al. Tension-free vaginal tape versus transobturator tape as surgery for stress urinary incontinence: results of a multicentre randomised trial. Eur Urol. 2007;52:1481-90.^,⁴⁵45. Kuuva N, Nilsson CG. A nationwide analysis of complications associated with the tension-free vaginal tape (TVT) procedure. Acta Obstet Gynecol Scand. 2002;81:72-7.^,⁸¹81. Shepherd JP, Jones KA, Harmanli O. Is antibiotic prophylaxis necessary before midurethral sling procedures for female stress incontinence? A decision analysis. Int Urogynecol J. 2014;25:227-33.^,⁸³83. Connolly TP. Necrotizing surgical site infection after tension-free vaginal tape. Obstet Gynecol. 2004;104:1275-6.⁾	0-2% ⁽²⁷27. Fischer A, Fink T, Zachmann S, Eickenbusch U. Comparison of retropubic and outside-in transoburator sling systems for the cure of female genuine stress urinary incontinence. Eur Urol. 2005;48:799-804.^,²⁹29. Porena M, Costantini E, Frea B, Giannantoni A, Ranzoni S, Mearini L, et al. Tension-free vaginal tape versus transobturator tape as surgery for stress urinary incontinence: results of a multicentre randomised trial. Eur Urol. 2007;52:1481-90.^,³⁶36. Costa P, Grise P, Droupy S, Monneins F, Assenmacher C, Ballanger P, et al. Surgical treatment of female stress urinary incontinence with a trans-obturator-tape (T.O.T.) Uratape: short term results of a prospective multicentric study. Eur Urol. 2004;46:102-6.^,³⁷37. Barber MD, Kleeman S, Karram MM, Paraiso MF, Walters MD, Vasavada S, et al. Transobturator tape compared with tension-free vaginal tape for the treatment of stress urinary incontinence: a randomized controlled trial. Obstet Gynecol. 2008;111:611-21.⁾
Bladder Injury	0.7 to 24% ⁽²⁸28. Laurikainen E, Valpas A, Kivelä A, Kalliola T, Rinne K, Takala T, et al. Retropubic compared with transobturator tape placement in treatment of urinary incontinence: a randomized controlled trial. Obstet Gynecol. 2007;109:4-11.^,⁴⁷47. Andonian S, Chen T, St-Denis B, Corcos J. Randomized clinical trial comparing suprapubic arch sling (SPARC) and tension-free vaginal tape (TVT): one-year results. Eur Urol. 2005;47:537-41.⁾	0-15% (12, 29, 48–50) ⁽¹²12. Latthe PM, Foon R, Toozs-Hobson P. Transobturator and retropubic tape procedures in stress urinary incontinence: a systematic review and meta-analysis of effectiveness and complications. BJOG. 2007;114:522-31. Review. Erratum in: BJOG. 2007:114:1311.^,²⁹29. Porena M, Costantini E, Frea B, Giannantoni A, Ranzoni S, Mearini L, et al. Tension-free vaginal tape versus transobturator tape as surgery for stress urinary incontinence: results of a multicentre randomised trial. Eur Urol. 2007;52:1481-90.^,⁴⁸48. Juma S, Brito CG. Transobturator tape (TOT): Two years follow-up. Neurourol Urodyn. 2007;26:37-41.^–⁵⁰50. Sung VW, Schleinitz MD, Rardin CR, Ward RM, Myers DL. Comparison of retropubic vs transobturator approach to midurethral slings: a systematic review and meta-analysis. Am J Obstet Gynecol. 2007;197:3-11.⁾
Urethral Injury	0.07 to 0.2% ⁽⁴⁴44. Gold RS, Groutz A, Pauzner D, Lessing J, Gordon D. Bladder perforation during tension-free vaginal tape surgery: does it matter? J Reprod Med. 2007;52:616-8.^,⁴⁵45. Kuuva N, Nilsson CG. A nationwide analysis of complications associated with the tension-free vaginal tape (TVT) procedure. Acta Obstet Gynecol Scand. 2002;81:72-7.⁾	0.1 to 2.5% ⁽³⁶36. Costa P, Grise P, Droupy S, Monneins F, Assenmacher C, Ballanger P, et al. Surgical treatment of female stress urinary incontinence with a trans-obturator-tape (T.O.T.) Uratape: short term results of a prospective multicentric study. Eur Urol. 2004;46:102-6.^,⁵¹51. Dmochowski RR, Blaivas JM, Gormley EA, Juma S, Karram MM, Lightner DJ, et al. Update of AUA guideline on the surgical management of female stress urinary incontinence. J Urol. 2010;183:1906-14.⁾
Urethral Erosion	0.03-0.8% ⁽⁴⁵45. Kuuva N, Nilsson CG. A nationwide analysis of complications associated with the tension-free vaginal tape (TVT) procedure. Acta Obstet Gynecol Scand. 2002;81:72-7.^,⁵²52. Collinet P, Ciofu C, Costa P, Cosson M, Deval B, Grise P, et al. The safety of the inside-out transobturator approach for transvaginal tape (TVT-O) treatment in stress urinary incontinence: French registry data on 984 women. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19:711-5.⁾	0.03 to 0.8% ⁽⁴⁵45. Kuuva N, Nilsson CG. A nationwide analysis of complications associated with the tension-free vaginal tape (TVT) procedure. Acta Obstet Gynecol Scand. 2002;81:72-7.^,⁵²52. Collinet P, Ciofu C, Costa P, Cosson M, Deval B, Grise P, et al. The safety of the inside-out transobturator approach for transvaginal tape (TVT-O) treatment in stress urinary incontinence: French registry data on 984 women. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19:711-5.⁾
Intestinal Injury	0.03 to 0.7% ⁽¹⁸18. Kobashi KC, Govier FE. Perioperative complications: the first 140 polypropylene pubovaginal slings. J Urol. 2003;170:1918-21.^,⁶³63. Starkman JS, Wolter C, Gomelsky A, Scarpero HM, Dmochowski RR. Voiding dysfunction following removal of eroded synthetic mid urethral slings. J Urol. 2006;176:1040-4. Erratum in: J Urol. 2006;176:2749.^–⁶⁵65. Smith AL, Moy ML. Modern management of women with stress urinary incontinence. Ostomy Wound Manage. 2004;50:32-9.⁾	0%
Vaginal Erosion	0-1.5% ⁽²⁸28. Laurikainen E, Valpas A, Kivelä A, Kalliola T, Rinne K, Takala T, et al. Retropubic compared with transobturator tape placement in treatment of urinary incontinence: a randomized controlled trial. Obstet Gynecol. 2007;109:4-11.^,²⁹29. Porena M, Costantini E, Frea B, Giannantoni A, Ranzoni S, Mearini L, et al. Tension-free vaginal tape versus transobturator tape as surgery for stress urinary incontinence: results of a multicentre randomised trial. Eur Urol. 2007;52:1481-90.⁾	0 to 10.9% ⁽²⁷27. Fischer A, Fink T, Zachmann S, Eickenbusch U. Comparison of retropubic and outside-in transoburator sling systems for the cure of female genuine stress urinary incontinence. Eur Urol. 2005;48:799-804.^,²⁹29. Porena M, Costantini E, Frea B, Giannantoni A, Ranzoni S, Mearini L, et al. Tension-free vaginal tape versus transobturator tape as surgery for stress urinary incontinence: results of a multicentre randomised trial. Eur Urol. 2007;52:1481-90.^,⁶⁶66. Anger JT, Litwin MS, Wang Q, Pashos CL, Rodriguez LV. Complications of sling surgery among female Medicare beneficiaries. Obstet Gynecol. 2007;109:707-14.^,⁶⁷67. Gurtcheff SE. Introduction to the MAUDE database. Clin Obstet Gynecol. 2008;51:120-3.⁾
UTI	7.4 to 13% ⁽⁴4. Barry C, Lim YN, Muller R, Hitchins S, Corstiaans A, Foote A, et al. A multi-centre, randomised clinical control trial comparing the retropubic (RP) approach versus the transobturator approach (TO) for tension-free, suburethral sling treatment of urodynamic stress incontinence: the TORP study. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19:171-8.^,²⁷27. Fischer A, Fink T, Zachmann S, Eickenbusch U. Comparison of retropubic and outside-in transoburator sling systems for the cure of female genuine stress urinary incontinence. Eur Urol. 2005;48:799-804.^,²⁸28. Laurikainen E, Valpas A, Kivelä A, Kalliola T, Rinne K, Takala T, et al. Retropubic compared with transobturator tape placement in treatment of urinary incontinence: a randomized controlled trial. Obstet Gynecol. 2007;109:4-11.^,³⁷37. Barber MD, Kleeman S, Karram MM, Paraiso MF, Walters MD, Vasavada S, et al. Transobturator tape compared with tension-free vaginal tape for the treatment of stress urinary incontinence: a randomized controlled trial. Obstet Gynecol. 2008;111:611-21.⁾	7.4 to 13% ⁽⁴4. Barry C, Lim YN, Muller R, Hitchins S, Corstiaans A, Foote A, et al. A multi-centre, randomised clinical control trial comparing the retropubic (RP) approach versus the transobturator approach (TO) for tension-free, suburethral sling treatment of urodynamic stress incontinence: the TORP study. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19:171-8.^,²⁷27. Fischer A, Fink T, Zachmann S, Eickenbusch U. Comparison of retropubic and outside-in transoburator sling systems for the cure of female genuine stress urinary incontinence. Eur Urol. 2005;48:799-804.^,²⁸28. Laurikainen E, Valpas A, Kivelä A, Kalliola T, Rinne K, Takala T, et al. Retropubic compared with transobturator tape placement in treatment of urinary incontinence: a randomized controlled trial. Obstet Gynecol. 2007;109:4-11.^,³⁷37. Barber MD, Kleeman S, Karram MM, Paraiso MF, Walters MD, Vasavada S, et al. Transobturator tape compared with tension-free vaginal tape for the treatment of stress urinary incontinence: a randomized controlled trial. Obstet Gynecol. 2008;111:611-21.⁾
Pain	4% ⁽⁷⁵75. Bong GW, Rovner ES. Vaginal erosion after hybrid midurethral sling placement. Urology. 2006;68:1343.e13-4.⁾	9.4% ⁽⁷⁵75. Bong GW, Rovner ES. Vaginal erosion after hybrid midurethral sling placement. Urology. 2006;68:1343.e13-4.⁾
Urgency “de novo”	0,2% −25% ⁽²⁸28. Laurikainen E, Valpas A, Kivelä A, Kalliola T, Rinne K, Takala T, et al. Retropubic compared with transobturator tape placement in treatment of urinary incontinence: a randomized controlled trial. Obstet Gynecol. 2007;109:4-11.^,⁸¹81. Shepherd JP, Jones KA, Harmanli O. Is antibiotic prophylaxis necessary before midurethral sling procedures for female stress incontinence? A decision analysis. Int Urogynecol J. 2014;25:227-33.^,⁸²82. Babalola EO, Famuyide AO, McGuire LJ, Gebhart JB, Klingele CJ. Vaginal erosion, sinus formation, and ischiorectal abscess following transobturator tape: ObTape implantation. Int Urogynecol J Pelvic Floor Dysfunct. 2006;17:418-21.⁾	0 to 15.6% ⁽²⁷27. Fischer A, Fink T, Zachmann S, Eickenbusch U. Comparison of retropubic and outside-in transoburator sling systems for the cure of female genuine stress urinary incontinence. Eur Urol. 2005;48:799-804.^,²⁸28. Laurikainen E, Valpas A, Kivelä A, Kalliola T, Rinne K, Takala T, et al. Retropubic compared with transobturator tape placement in treatment of urinary incontinence: a randomized controlled trial. Obstet Gynecol. 2007;109:4-11.^,⁸³83. Connolly TP. Necrotizing surgical site infection after tension-free vaginal tape. Obstet Gynecol. 2004;104:1275-6.⁾
Bladder Outlet Obstruction	6 to 18.3% ⁽¹²12. Latthe PM, Foon R, Toozs-Hobson P. Transobturator and retropubic tape procedures in stress urinary incontinence: a systematic review and meta-analysis of effectiveness and complications. BJOG. 2007;114:522-31. Review. Erratum in: BJOG. 2007:114:1311.^,²⁴24. Barber MD, Gustilo-Ashby AM, Chen CC, Kaplan P, Paraiso MF, Walters MD. Perioperative complications and adverse events of the MONARC transobturator tape, compared with the tension-free vaginal tape. Am J Obstet Gynecol. 2006;195:1820-5.^,²⁶26. Novara G, Galfano A, Boscolo-Berto R, Secco S, Cavalleri S, Ficarra V, et al. Complication rates of tension-free midurethral slings in the treatment of female stress urinary incontinence: a systematic review and meta-analysis of randomized controlled trials comparing tension-free midurethral tapes to other surgical procedures and different devices. Eur Urol. 2008; 53:288-308.^,⁷⁵75. Bong GW, Rovner ES. Vaginal erosion after hybrid midurethral sling placement. Urology. 2006;68:1343.e13-4.^,⁹⁴94. Nilsson CG, Kuuva N, Falconer C, Rezapour M, Ulmsten U. Long-term results of the tension-free vaginal tape (TVT) procedure for surgical treatment of female stress urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct. 2001;12: Suppl 2:S5-8.⁾	3.0-11% ⁽¹²12. Latthe PM, Foon R, Toozs-Hobson P. Transobturator and retropubic tape procedures in stress urinary incontinence: a systematic review and meta-analysis of effectiveness and complications. BJOG. 2007;114:522-31. Review. Erratum in: BJOG. 2007:114:1311.^,²⁴24. Barber MD, Gustilo-Ashby AM, Chen CC, Kaplan P, Paraiso MF, Walters MD. Perioperative complications and adverse events of the MONARC transobturator tape, compared with the tension-free vaginal tape. Am J Obstet Gynecol. 2006;195:1820-5.^,²⁶26. Novara G, Galfano A, Boscolo-Berto R, Secco S, Cavalleri S, Ficarra V, et al. Complication rates of tension-free midurethral slings in the treatment of female stress urinary incontinence: a systematic review and meta-analysis of randomized controlled trials comparing tension-free midurethral tapes to other surgical procedures and different devices. Eur Urol. 2008; 53:288-308.^,⁷⁵75. Bong GW, Rovner ES. Vaginal erosion after hybrid midurethral sling placement. Urology. 2006;68:1343.e13-4.^,⁹⁴94. Nilsson CG, Kuuva N, Falconer C, Rezapour M, Ulmsten U. Long-term results of the tension-free vaginal tape (TVT) procedure for surgical treatment of female stress urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct. 2001;12: Suppl 2:S5-8.⁾
Urinary Retention	4.1% −19.5% ⁽²2. Abouassaly R, Steinberg JR, Lemieux M, Marais C, Gilchrist LI, Bourque JL, et al. Complications of tension-free vaginal tape surgery: a multi-institutional review. BJU Int. 2004;94:110-3.^,²⁸28. Laurikainen E, Valpas A, Kivelä A, Kalliola T, Rinne K, Takala T, et al. Retropubic compared with transobturator tape placement in treatment of urinary incontinence: a randomized controlled trial. Obstet Gynecol. 2007;109:4-11.^,²⁹29. Porena M, Costantini E, Frea B, Giannantoni A, Ranzoni S, Mearini L, et al. Tension-free vaginal tape versus transobturator tape as surgery for stress urinary incontinence: results of a multicentre randomised trial. Eur Urol. 2007;52:1481-90.⁾	2.7% −11% ⁽²⁸28. Laurikainen E, Valpas A, Kivelä A, Kalliola T, Rinne K, Takala T, et al. Retropubic compared with transobturator tape placement in treatment of urinary incontinence: a randomized controlled trial. Obstet Gynecol. 2007;109:4-11.^,²⁹29. Porena M, Costantini E, Frea B, Giannantoni A, Ranzoni S, Mearini L, et al. Tension-free vaginal tape versus transobturator tape as surgery for stress urinary incontinence: results of a multicentre randomised trial. Eur Urol. 2007;52:1481-90.^,³⁷37. Barber MD, Kleeman S, Karram MM, Paraiso MF, Walters MD, Vasavada S, et al. Transobturator tape compared with tension-free vaginal tape for the treatment of stress urinary incontinence: a randomized controlled trial. Obstet Gynecol. 2008;111:611-21.⁾

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