European Urology

Abstract

Background

Suburethral slings are commonly used for the surgical treatment of female stress incontinence; occasionally they can cause erosion and dyspareunia.

Objectives

The primary aim of this study is to determine the outcome after reclosure of the vaginal epithelium for suburethral sling erosion. Sexual function was assessed before and after intervention using the Female Sexual Function Index (FSFI) questionnaire.

Design, setting, and participants

This was a prospective case-controlled study in which, between December 2005 and December 2007, we included patients who were referred to the Department of Urogynaecology because of vaginal erosion after suburethral sling insertion for urinary stress incontinence. For evaluation of sexual function, all patients filled in an FSFI questionnaire before intervention and at follow-up.

All patients underwent gynaecological examination including colposcopy, and the site and size of the defect were noted.

Intervention

The edge of the vaginal epithelium was trimmed, mobilized, and closed with interrupted vertical Vicryl mattress sutures in a single layer.

Measurements

FSFI questionnaire and clinical findings.

Results and limitations

Twenty-one patients were included in the study. Eighteen patients with larger defects were operated on, and three defects healed after topical application of estrogen cream.

In 16 patients, the defect had healed at follow-up; two patients with persisting defects were brought back to surgery and the procedure was repeated, paying particular attention to tension-free adaptation of vaginal tissue. In one patient, partial sling removal was performed after the second failed intervention.

The domains of desire (p < 0.0001), arousal (p < 0.0003), lubrication (p < 0.0001), satisfaction (p < 0.0130), and pain (p < 0.0001) improved significantly. Orgasm remained unchanged (p = 0.4130; all two-tailed t-test).

Conclusion

Suburethral erosion can be treated effectively by resuturing. Sexual function is improved in regard to desire, arousal, lubrication, satisfaction, and pain, but not orgasm.

In septic patients and patients with a history of radiation, grossly infected tissue, or severe pain, excision of the mesh needs to be considered.

Take Home Message

Erosion after sling insertion can be treated by reclosure of the epithelium with a short-term success rate of 89% and improvement of sexual function.