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abstract

411 - MANAGEMENT OF BLADDER OUTLET OBSTRUCTION AFTER A SINGLE-INCISION MIDURETHRAL SLING PROCEDURE USING TAPE ELONGATION

411

MANAGEMENT OF BLADDER OUTLETOBSTRUCTION AFTER A SINGLE-INCISION MIDURETHRAL SLING PROCEDURE USINGTAPE ELONGATION

M. HUNG;
Obstetrics &Gynecology, Asia Univ. Hosp., Taichung, Taiwan.

Introduction: Bladder outletobstruction (BOO) is reported to occur in 2~15 % of women afteranti-incontinence surgery.1 Most surgeons performedurethrolysis or sling incision for iatrogenic BOO. However, recurrentstress urine incontinence (SUI) is seen in approximately 20 % ofwomen after sling incision.1,2
Objective: Theaim of this study was to report a high rate of BOO during learningperiod of a single-incision mid-urethral sling procedure (AjustHelical, C.R. Bard Inc., New Providence, NJ, USA) with obturatoranchorage, and the sling elongation method we used to manage theproblem.
Methods: A retrospective cohort study wasconducted between April 2013 and April 2015.Women with SUI whounderwent either TVTO or Ajust Helical were recruited. Trials oftransurethral sling depression were given for patients with BOO inpost-op 1 week. For patients with persist BOO, incision of sling andelongation with another piece of polypropylene mesh were performed.(Figure 1) We analyzed the clinical characteristics, overallsuccess rates and recurrent rates of SUI of these patients.
Results:A total of 119 patients were enrolled, including 61 receiving TVTOand 58 receiving Ajust Helical. Clinical data in both groups weresimilar, except a significant higher post-op BOO rate in AdjustHelical group. (3.3% in TVTO group; while 17.2% in Adjust Helicalgroup, P=0.014) (Table 1) Characteristics about patients withpost-op BOO(N=12) were listed in Table 2. Most BOO of AdjustHelical procedure occurred in the earlier cases (no BOO after caseNo. 27). Furthermore, all patents had immediate relief of obstructivevoiding symptoms after elongation of sling. Only one patient (1/12,8.3%) suffered from recurrent SUI at a median 24 months follow-upperiod.
Conclusions: A high rate of BOO is noted duringlearning period of Adjust Helical single incision sling procedure. Itis not possible of rectification by transurethral sling depressionbecause of strong obturator anchorage. However, sling elongationtechnique solves the obstruction and maintains the anti-incontinenceefficacy.
References: 1.International urogynecologyjournal. 2013;24(12):2145-2146. 2.Urology. 2012;80(3):551-555.