Complications of Slings

The risk of sling erosion is high among patients who underwent synthetic sling placement compared with non-synthetic material grafts. The Female Stress Urinary Incontinence Panel of the American Urological Association reported 12 vaginal or urethral erosions in 1715 patients who underwent autologous pubovaginal sling placement (0.007%) compared with 41 erosions in 1515 patients treated with various synthetic slings (0.027%).1 The mechanism of erosion is thought to be secondary to delayed infection of synthetic materials resulting in vaginal erosion, and excessive tension applied to the sling or unrecognized urethral injury at the time of operation resulting in urethral erosion. The symptoms of erosion may include vaginal and urethral pain, irritative voiding symptoms, vaginal discharge, or bleeding. Erosions can be detected by physical examination and urethroscopy.

Overall, new-onset urge incontinence has been reported in as many as 20% of patients after sling operations.17

Urinary retention, or an inability to void after a pubo-vaginal sling procedure, is common especially during the initial postoperative period. This complication may occur because of impaired detrusor contractility, bladder outlet obstruction, or both. To reduce the risk of this complication, prior identification of poor detrusor contractility is required, and the patient should be advised of the risk of postoperative voiding difficulties. Placement of slings without tension as in the TVT procedure has led to a substantial decrease in obstructive complications. Further reduction of this complication has been achieved by adopting the transobturator technique (TOT).

Recurrent stress incontinence, urinary tract infections, incisional hernias, and pelvic hematoma may also develop as complications of sling procedures. Bladder perforation, blood vessel, or nerve injury can occur during placement of slings. Vaginal mucosal slings are associated with the risk of epithelial inclusion cyst formation.19

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