Long term results after complication of "prophylactic" suburethral tape placement

Introduction: To report the long term result following complications that arose after "prophylactic" placement of midurethral sling (MUS) during prolapse repair. Materials and methods: After institutional review board approval, the records of patients who presented with complications of prophylactic MUS and had a minimum 1 year follow up after repair of their complication were reviewed. Data collected included age, body mass index, operative note documenting primary procedure and type of prophylactic MUS, indication for prophylactic MUS, presenting complaint, duration and severity of symptoms since MUS placement, operative events if any, and outcomes after repair of the complication. Results: Between 2007 and 2009, ten patients presented with complications of prophylactic MUS and underwent transvaginal suburethral tape excision. At a median 35 (mean 36) month follow up post-MUS excision, a secondary midurethral stricture, an infected paravesical retropubic tape, and symptomatic incontinence and/or secondary anterior compartment prolapse requiring additional repair in five patients, occurred. Three patients experienced residual lower urinary tract symptoms (LUTS). Pain resolved in all four patients. Conclusion: "Prophylactic" placement of a MUS can be fraught with complications requiring MUS removal, followed by additional corrective surgery in some, and persistent LUTS managed by continuous pharmacological therapy in others, thus requiring careful consideration and full patient agreement.