Complications of Sling Procedures A Comprehensive Review

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Slide 1 :

COMPLICATIONS OF ANTI-INCONTINENCE SLING PROCEDURES: A COMPREHENSIVE REVIEW Edward Stanford MD MS FACOG FACS Professor Ob/Gyn Chief Gynecologic Services/Urogynecology University of Tennessee, Memphis Marie Fidelia R. Paraiso, MD, FACOG, FACS Cleveland Clinic Cleveland, Ohio

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DISCLOSURE None

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Objective To review the published complications associated with sling procedures. Methods Reports of complications for all types of anti-incontinence sling procedures were analyzed Pubmed listings were searched using key words related to sling procedures and associated complications without date or language restrictions through May 2007 The MAUDE database (Manufacturer and User Facility Device Experience database) was referenced for specific device and procedure related complications

Slide 4 :

SLING RELATED COMPLICATIONS Voiding dysfunction - Detrusor overactivity (DO) Urinary retention Erosion/Extrusion Impact on Quality of Life - Dyspareunia Infection Hematoma Pain Abdominal or Pelvic Organ Injury Systemic Complications

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SLING RELATED COMPLICATIONS Complications Voiding dysfunction DO Urinary retention Pain Erosion/Extrusion Infection Impact on QOL Abd/Pelv injury Hematoma Studies Patients Overall Incidence 8 881 16.3% 20 1950 15.4% 13 1200 14.2% 6 597 7.3% 16 2197 6.0% 19 1487 5.5% 2 175 4.3% 10 1816 3.3% 4 3691 2.7% 13994 8.3%

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SLING RELATED COMPLICATIONS

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SLING RELATED COMPLICATIONS Isolated case reports DVT Sepsis Death

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Cure and Failure Rates Subjective Cure Rates 16 studies/1782 patients/95% (63-99%) Objective Cure Rates 15 studies/1545 patients/81% (51-9%) Failure Rates 9 studies/742 patients/11% (4-37%)

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CONCLUSIONS Complications associated with sling procedures occur in approximately 8.2% of slings overall. Suburethral sling related complications are likely under-reported in the published medical literature and in the MAUDE database This review summarizes incidence of known complications for all types of sling procedures Some complications are common to all sling techniques; however, with the development of newer minimally invasive slings, device-related complications require more investigation An understanding of the incidence of reported publications is important in providing informed consent to patients

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