**16. Success and failure**

Jain et al (2011) did a systematic review of TVT and TOT in the treatment of Mixed Urinary Incontinence (MUI). The subjective cure rate in 7 prospective trials was 56.4% (IC 95% 45.7- 69.6%) in a follow up period of 34.9±22.9 months. The cure rate for stress urinary incontinence varied from 85% to 97% in a follow up period of 6 to 31 months. TVT and TOT have a similar cure in mixed urinary incontinence. Madhuvrata et al (2011) in a systematic review and meta-analysis of the mini-sling (SIMS) compared the retropubic procedure: TVT (9 studies were included) and TVT-O (7 studies were included). The objective short term cure rate (6-12 months) was greater in urethral sling procedures than in mini-slings (SIMS) with a RR 1.20 (IC 95% 1.01-1.43) and RR 1.18 (IC 95% 1.04-1.34); a second surgery was necessary in the SIMS group with a RR 0.15 (IC 95% 0.05-0.42). Novara et al (2010) in a systematic review and meta-analysis of 39 papers reported that patients who had a suburethral mesh inserted the objective cure rate had an OR: 0.38 (IC95% 0.25-0.57; p=<0.0001) compared to the patients who had a Burch colpo-suspension procedure, although they had a high bladder perforation risk with an OR of 4.94 (IC 95% 2.09-11.68; p= 0.00003). Patil (2011) in a total of 12977 surgeries performed in 68 centers in the United Kingdom, 313 patients (2.4%) failed to sub-urethral slings. Chen et al (2011) in 30 patients followed up 1 year, who had a TVT-secur inserted, the success rate decreased significantly from 83.3% one month after surgery to 60.0% one year after the procedure.

Surgical Complications with Synthetic Materials 255

Rigaud et al (2010) said that when the patient refers perineal pain or chronic pelvic pain, immediately or shortly after insertion of a TVT or TOT Kit, this is probably associated directly or indirectly to a nerve injury (obturator nerve or pudendal nerve); diagnosis is made with the history that pain started after insertion of the kit and it can be confirmed with infiltration of local anesthesia through the mesh. This complication may be underestimated.

Treatment of complications with these kits is still not standardized and it is something we will have to work on. When complications are severe, a multidisciplinary team is necessary

Complications due to punctures are caused by the passage of the kit's trocar, it can injure the urethra or the bladder, therefore, during the retropubic inside-out or outside-in procedure, a cystoscopy using a 700 lens should be performed in order to see the dome of the bladder and lateral walls; and a 00 to 300 lens to properly evaluate the urethra; so that under this direct view we can see whether the trocar is inside the bladder or urethra before placing the mesh. In the event the trocar punctures the bladder or urethra, it can be removed and inserted again. If there is no evidence of puncture to the urethra and/or bladder, it is now possible to place the mesh and a cystoscopy should be repeated. In the event of bladder injury, the size of the puncture should be measured and if small, a continuous drainage should be left with a Foley catheter for 48 to 72 hours. When the bladder damage is larger, a primary repair is necessary with 2 layers of absorbing suture (vicryl) and a continuous

Flock et al (2011) reported 7 patients with TVT who had hemorrhage of 250ml to 400 ml that was managed with cautherization, compression or tamponade. Zorn et al (2005) recommend an exploratory laparotomy to repair the vascular damage and for proper hemostasis, or an embolization in patients who present massive bleeding after placement of the TVT; if we

Hubka et al (2010) recommend the patient be placed in a proper position in order to stay away from the obturator neurovascular bundle, this way, the success rate increases and the

Abouassaly et al (2004) recommend in patients with voiding dysfunctions, the use of clean intermittent catheterization and if it has to be for a longer period of time, the mesh must be

Abouassaly et al (2004) reported that when an infectious process arises, a culture must be performed and antibiotics should be prescribed depending on the sensitivity obtained; and as reported by Flam et al (2009) hyperbaric oxygen can be used to improve oxygenation of the tissue involved with excellent results. Abouassaly et al (2004) recommend for intravaginal mesh erosion, partial resection of the meshes and repair of the vaginal epithelium if the patient refers symptoms if not, she can just be observed as reported by

released, and in patients who continue with voiding disorders the mesh must be cut.

to provide the best treatment and obtain favorable results for the patient.

drainage using a Foley Catheter for 5 to 7 days should also be placed.

**18.2 Treatment of intra-operative complications** 

have this technique it provides good results.

number of neurovascular damage decrease.

**18.3 Treatment of post-operative complications** 

**18.1 Treatment** 
