Complications After Midurethral Sling Procedures Not Isolated, Research Shows

March 8, 2014

With the recent position statement released by two medical groups specializing in female pelvic medicine, the controversy surrounding the vaginal mesh device appears to become more heated. Aside from expressing their support for midurethral mesh slings for the repair of stress urinary incontinence (SUI), they have also put the blame on lawyers and media for the vaginal mesh controversy. While this may be the position of these organizations, it cannot be ignored that complications associated with this specific sling device abound, based on results of different studies and statements from numerous pelvic surgeons.

Considered as among the more common and severe complications linked to midurethral sling procedures are the following:


De Novo Urge Incontinence


It has been reported that incidence of de novo incontinence after a midurethral procedure may reach as high as 26 percent. When urge urinary incontinence appears after a sling procedure, the complication of de novo urgency is said to have occurred. To be considered as a complication, this must persist six months after the surgery and must not have been present before undergoing the operation. For a woman who may have just wanted to rid herself of SUI and has instead ended up with another form of urinary incontinence can be very tough and frustrating.


Organ Perforation


When parts of the mesh, particularly the rough edges, puncture the nearby pelvic organs causing damages, a patient may be considered as experiencing organ perforation. While almost all pelvic organs may be exposed to this complicaton, the most common perforation is that of the bladder which has been recorded to happen in seven to ten percent of all cases. Commonly affected also is the urethra and the bowels or the rectum in rare cases. The complication, which may cause great pain and discomfort, has also been regarded as one of the most lethal especially when urine or feces gets into the bloodstream that may trigger life-threatening infections.


Vascular Injury


With the possibility of death very high, this complication, which may involve injury to the blood vessel, has been recognized as the most feared adverse effect, although incidence may not be as high compared to others. Of the sling procedures used by surgeons, the most number of cases reported were those after midurethral operation. In one study, it was reported that blood loss of over 250 ml was experienced by five percent of patients who underwent this type of sling procedure.


Erosion of Mesh


The occurrence of mesh erosion, just like the repairs for pelvic organ prolapse (POP) and other types of sling procedures, is a common complication after using the midurethral method in the treatment of SUI. Mesh has been known to erode into the urethra and bladder causing the patient to experience symptoms such as pain during urination, dyspareunia or painful sexual intercourse, a feeling of burning sensation, and a host of urinary problems.


When the bowel and colon are the organs affected in the mesh erosion, symptoms such as severe pain, fever, infections, abscess, and even the deadly sepsis may develop. It has also been noted that this complication may appear months or even years after the surgery and may manifest in the form of abdominal bloating, pain, constipation, and painful bowel movements.




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