Attachment of a sling rescue suture to Midurethral tape for management of potential postoperative voiding dysfunction

Aims To investigate the utility of a polypropylene sling rescue suture (SRS) attached to mid‐portion of the mid‐urethral sling tape procedure for in office sling loosening/release using a defined algorithm. Methods A surgical database search was performed for slings performed by the authors. During the course of the procedure a polypropylene suture was passed through the mid‐portion of the sling tape and allowed to exit through the vaginal mucosa closure such that the tail of the suture loop rested in the vagina. Patients were managed by a predetermined algorithm to make decisions about (1) in office polypropylene suture removal, (2) manipulation of polypropylene suture in attempt to loosen the sling, and (3) localization and incision of the sling tape in the office using polypropylene suture. Results One hundred eighty‐four cases were identified, 70/184 of which were outpatient slings, and 114/184 of which had reconstructive surgery and a sling procedure. In the outpatient sling group 2/70 (3%) had resolution of voiding dysfunction with sling manipulation using polypropylene suture, 2/70 (3%) required sling excision in office. In the group with concomitant pelvic reconstruction, 4/114 had elevated postvoid residuals and ultimately required sling excision. 6/184 (3%) in the entire group required sling excision in the office. 178/184 (97%) had normal voiding. Conclusions The polypropylene suture facilitated easy release of obstructive slings. It was successful in normalizing the voiding function in patients with disrupted voiding pattern, but not in those with high post‐void residuals who had failed a trial of intermittent catherization. Neurourol. Urodynam. 28:990–994, 2009. © 2009 Wiley‐Liss, Inc.