TISSUE REACTION TO EXPANDED POLYTETRAFLUOROETHYLENE SUBURETHRAL SLING FOR URINARY-INCONTINENCE - CLINICAL AND HISTOLOGIC-STUDY

OBJECTIVE: The use of expanded polytetrafluoroethylene suburethral sling for recurrent urinary incontinence has shown an excellent cure rate but a number of complications. This study was designed to evaluate patients who had tissue reaction or removal of the sling, to determine potential causes, clinical course, and eventual outcome. STUDY DESIGN: A retrospective review of consecutive charts was completed for 115 patients who had suburethral sling surgery with expanded polytetrafluoroethylene. Patients having tissue reaction or removal of sling material were identified, and eight removed sling specimens were analyzed histologically with Milligan's trichrome, hematoxylin and eosin, fibrin, Brown-Brenn bacteria, and Dahl's calcium stains. RESULTS: Twenty-four patients had reactions to the sling material, and 23 slings were eventually removed. Seventeen of 23 patients having sling removal remained continent. Histologic evaluations revealed gram-positive cocci in all expanded polytetrafluoroethylene patch interstices. Fibrous tissue, fibroblasts, and collagen were present in one half of specimens. CONCLUSION: There is a 23% reaction or removal rate for expanded polytetrafluoroethylene suburethral sling procedures. Seventeen of 23 patients remained continent in spite of sling removal. Histologic studies showed gram-positive cocci in the patch interstices, although prophylactic antibiotic coverage did not prevent infection and cultures from the vaginal or abdominal reaction sites did not reveal a significant growth of organisms. Patients need to be aware of the high complication rate for this suburethral sling procedure, and physicians need to work further to modify sling materials and techniques to reduce complications.