The commonest indications for repeat surgery following mid-urethral tapes (MUT) are persistent/recurrent stress urinary incontinence (SUI), intractable pain, vaginal extrusion, voiding dysfunction (VD) or intractable detrusor overactivity (DO). Urethral complications of MUT (extrusion, fistula or loss) are extremely rare and the functional outcomes of their treatment relatively unknown. We examined the causes, presentations, treatment and outcomes of urethral complications of MUT.

A retrospective analysis of a prospectively acquired database of patients having surgical management of urethral complications of MUT between 2008−2018 was performed. All patients were evaluated with urodynamics preoperatively and were reassessed with videourodynamics(VUDS) postoperatively if symptomatic. Patient demographics, operative history, type of surgery, functional outcomes and any re−interventions were documented.

35 patients of median age 54(33−82) years were identified, with the median time between tape insertion to removal of 5(1−15) years. Procedures performed to manage urethral complications, any simultaneous and subsequent interventions are shown in Table 1.
Pre−operative urodynamics showed SUI in 18/35 (51%), DO wet in 4/35 (11%), and DO dry in 4/35 (11%). 26/35 (74%) had repeat VUDS assessment; 21/26 (81%) had recurrent/persistent SUI, 5/26 (19%) had recurrent/persistent mixed urinary incontinence (MUI) and 5 (19%) had DO dry. 
20/34 (59%) went on to have further SUI surgery with cure or improvement in 15/20 (75%). 13 women had rectus fascial sling -9 are dry or improved. 5 had colposuspension -4 are dry or improved. 1 had Bulkamid injection and 1 had bladder artificial urinary sphincter – both are dry.
Women who had persistent significant SUI had a minimum of 2 previous surgical procedures for SUI prior to their index MUT insertion. Both women who had simultaneous procedures for SUI at time of management of their tape complication also suffered persistent significant SUI.

Vaginal removal of mid urethral tape, urethral repair and modified Martius labial fat pad (MlFP) interposition results in resolution of pain and a useable urethra in 97%. SUI persists or recurs in 74%. 59% require further SUI surgery, which has a 75% success rate.

It is important to counsel patients having surgery for tape related urethral complications accurately regarding functional outcomes and the need for further interventions.