Outlet obstruction after sling surgery

Urethral obstruction is not an uncommon complication after sling surgery for female stress urinary incontinence (SUI). This paper focuses on this complication in the context of the mid-urethral synthetic sling, which is now the predominate surgical option used by many surgeons in the treatment of female SUI. The epidemiology and risk factors predisposing to sling obstruction is reviewed, followed by a description of clinical features used in supporting the diagnosis. The use of urodynamics in conjunction with translabial ultrasound as a novel approach to assess the position of the sling and its relation to the urethra is explained. This is particularly important in the understanding of why the sling obstructs from an anatomical standpoint. The paper concludes with a brief overview on treatment options.