PD05-04 MANAGEMENT OF UI RECURRENCE AFTER MUS EXPLANTATION FOR PELVIC OR PERINEAL PAIN Article Swipe
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· 2018
· Open Access
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· DOI: https://doi.org/10.1016/j.juro.2018.02.412
You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Female Incontinence: Therapy I1 Apr 2018PD05-04 MANAGEMENT OF UI RECURRENCE AFTER MUS EXPLANTATION FOR PELVIC OR PERINEAL PAIN Maximilien Baron, Marie-Aimée Perrouin-Verbe, Oussama Hedli, Loic Le Normand, Amélie Levesque, and Jerome Rigaud Maximilien BaronMaximilien Baron More articles by this author , Marie-Aimée Perrouin-VerbeMarie-Aimée Perrouin-Verbe More articles by this author , Oussama HedliOussama Hedli More articles by this author , Loic Le NormandLoic Le Normand More articles by this author , Amélie LevesqueAmélie Levesque More articles by this author , and Jerome RigaudJerome Rigaud More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.412AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Surgical removal of mid-urethral slings (MUS) for pelvic or perineal pain improved pain in 68% of cases but is associated with a risk of UI recurrence. There is no consensus of how to manage UI after MUS surgical removal. We evaluate UI treatment after MUS surgical removal for pelvic or perineal pain. METHODS From November 2004 to January 2016, 82 patients who underwent removal of MUS for pelvic pain, were prospectively followed.32 TVT were removed using transperitoneal laparoscopy while 50 TOT were removed through transvaginal and groin approach. Pain and need for UI re-treatment were prospectively evaluated. Urge UI (UUI), stress UI (SUI) and mixed UI (MUI) were differentiated with clinical examination and, if needed, urodynamic evaluation. RESULTS Median follow-up wa 8.4 months [0.2-135.7], 36 patients (43.9%) were still continent after tape removal while 46 (56.1%, 15 TVT, 31 TOT, p= 0.26) had UI: 1 UUI, 36 SUI and 9 MUI. Of those 46, 15 (32.6%) were still painful. One patient with UUI and 6 with MUI were successfully treated with antimuscarinics including 1 who performed also pelvic floor muscle training and 1 who underwent Burch procedure. Three were treated with neuromodulation (sacral (SNS) or tibial) including 1 who had Adjustable Continence Therapy (ACT) balloons implanted along with SNS. In patients with SUI (n=36), 6 were lost to follow-up before any treatment attempt. Nine patients (19.5%) who reported mild SUI, were satisfied and did not required any other treatment. Two were managed and cured with pelvic floor muscle reeducation. Four were still painful and focused on pain treatment with no treatment for urinary incontinence. Fifteen patients (41.6%) underwent continence re-surgery: 3 Burch procedure, 2 Artificial Urinary Sphincter (AUS), 3 ACT balloons and 7 retropubic tape specially for patients who had TOT during first procedure. Of 18 patients (41.3%) with SUI and MUI reoperated, 4 were still incontinent: 2 ACT, 1 TVT and 1 Burch. Only one patient had de novo pelvic pain after burch procedure. Three of them had an AUS successfully implanted afterward. Overall, 17 (94.4%) reoperated patients achieved full continence at lost to follow-up. CONCLUSIONS Recurrent UI after tape removal for chronic pain occurs in 56.1% of cases. UI is mild and do not require any treatment or antimuscarinic medication alone in 32.6% of cases. 41.3% of patients with recurrent UI undergo continence surgery with 94.4% who achieved full continence after one or two procedures. Retropubic tape (TVT) is possible in patients previously implanted with TOT with no recurrent of pain. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e146 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Maximilien Baron More articles by this author Marie-Aimée Perrouin-Verbe More articles by this author Oussama Hedli More articles by this author Loic Le Normand More articles by this author Amélie Levesque More articles by this author Jerome Rigaud More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...
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