Outcomes of Sling Removal in Women with Chronic Voiding Dysfunction: A Retrospective Observational Study.

Abstract

Stress urinary incontinence (SUI) is a common condition that can significantly impair a woman's quality of life. While initial management includes conservative treatments, surgical options are recommended in refractory cases. Suburethral slings are currently one of the most widely recommended surgical treatments due to their high long-term efficacy. However, complications such as postoperative urinary retention can occur and may lead to chronic voiding dysfunction when not promptly diagnosed and managed.<h4>Background/objectives</h4>The aim of this study was to evaluate the long-term voiding function in women undergoing delayed sling removal or incision for neglected chronic voiding dysfunction.<h4>Methods</h4>This retrospective study examined women with chronic voiding dysfunction occurring at least one year after suburethral sling placement for SUI. Preoperative evaluation included comprehensive history, physical examination, urethral ultrasound, uroflowmetry, and urodynamic studies. Surgical interventions consisted of partial or complete sling removal or sling incision (unilateral or bilateral). Postoperative follow-up was conducted at one month and then at 12 months, including clinical examination, ultrasound, and symptom assessment.<h4>Results</h4>Sixteen patients were included in the study, all of whom presented with urodynamic confirmation of voiding dysfunction. Following surgical intervention, a significant improvement was observed in voiding symptoms and overall symptoms (<i>p</i> < 0.01). Notably, only one patient experienced persistent voiding difficulties, although complete symptom remission was achieved following sacral neuromodulation.<h4>Conclusions</h4>Sling removal or incision has proven to be an effective approach in resolving the majority of cases of neglected chronic voiding dysfunction. These findings suggest that, when appropriately performed, surgical intervention can substantially alleviate symptoms and improve patient well-being, providing an effective therapeutic option for what is often a debilitating condition.