E-Posters-Correlation between Midurethral Sling Migration and the Development of de Novo Overactive Bladder Symptoms after midurethral Sling Placement with Tension-free Vaginal Tape: A Case Series

Correlation between Midurethral Sling Migration and the Development of de Novo Overactive Bladder Symptoms after midurethral Sling Placement with Tension-free Vaginal Tape: A Case Series - Mary Duarte Thibault, MD

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This case series discusses the correlation between midurethral sling (MUS) migration and the development of de novo overactive bladder (OAB) symptoms. MUS is a commonly used surgical treatment for stress urinary incontinence (SUI). However, there is a reported risk of sling revision or removal, as well as the development of OAB symptoms. OAB that develops after MUS placement is considered to be related to iatrogenic obstruction. The three patients in this case series were all young and physically active. The average age of patients undergoing MUS surgery is typically 40 years, but little is known about how physical activity impacts the risk of MUS migration and de novo urgency. The case series suggests that an interrupted stitch may be prudent in highly physically active patients to prevent sling migration. Known risk factors for voiding dysfunction following MUS placement include concurrent procedures and pre-existing obstructive symptoms. The three patients in the case series had MUS placed retropubically, and all experienced OAB symptoms that were refractory to medical therapy or had exam findings concerning MUS migration. They underwent excision of their MUS and replacement MUS were placed retropubically and tacked down with suture peri-urethrally to prevent repeat migration. Two of the three patients experienced significant improvement of symptoms postoperatively. The latency to revision ranged from 13 months to almost 12 years. This case series suggests that there may be a correlation between MUS migration and the development of de novo OAB symptoms, and that specific techniques may be employed to prevent migration in physically active patients. Further research is needed to better understand the relationship between sling migration and de novo urgency, as well as the optimal techniques for preventing this occurrence.

Keywords

midurethral sling

MUS migration

de novo overactive bladder

surgical treatment

stress urinary incontinence

iatrogenic obstruction

physical activity

voiding dysfunction

retropubic placement

symptom improvement