Symptoms after Unsuccessful Sling are Related to Choice of Materials
Drs. Kim Kenton, Mary Pat FitzGerald, Linda Brubaker
Loyola University Medical Center
Maywood, Illinois

Objective:  To describe characteristics of women presenting to our tertiary care Pelvic Medicine Center who had undergone prior suburethral sling procedures.
Materials and Methods:  Our database was searched for women who had undergone prior suburethral slings and whose symptoms warranted urodynamics from July 1997 to July 2001.
Results:  Twenty-one women were identified who had undergone prior suburethral slings at outside centers.  These women had a median age of 49 years (range 33-73), and a median parity of 3 children (0-7).  The majority (90%) were Caucasian.  Sixty-two percent of the women were postmenopausal, and 70% of those were on hormone replacement therapy.  Seventy-one percent had Stage 0 or I prolapse, 14% had Stage II, and only 3 women (15%) had advanced Stage III or IV prolapse.  Half (11 of 21) of the slings were done with bone anchors.  Seven of 11 (64%) women with bone anchors had radiologic evidence that at least one bone anchor was no longer in the pubic bone.  A variety of materials were used for the slings.  Below is a table of the postoperative symptoms and urodynamic findings of the women.

Four women presented with erosion of the sling into the vagina requiring surgical removal – two donor fasical slings and two synthetic slings – and 5 women had repeat sling procedures – 3 donor fascial slings and 2 synthetic slings. 
Conclusions:  The presenting symptoms following unsuccessful slings are related to choice of materials.  Not surprisingly, cure rates of GSI are inversely related to voiding dysfunction.  Women with prior donor fascial slings were significantly more likely to have persistent stress incontinence, while women with autologous fascial slings were more likely to have elevated PVRs.