Can a bladder sling break and cause pain?

Bladder Sling Complications: Breakage and Pain

Yes, a bladder sling can break or erode, causing significant pain and other urinary symptoms that negatively impact quality of life. 1

Mechanisms of Sling-Related Pain

Bladder slings can cause pain through several mechanisms:

1. Erosion: The most serious complication where the sling material breaks through tissue.

   • Urethral erosion presents with recurrent UTI symptoms (66%), overactive bladder symptoms (52%), and recurrent incontinence (42%) 1
   • Bladder erosion typically causes persistent dysuria, hematuria, and recurrent infections 2

2. Mesh breakage/fragmentation: Can occur over time, leading to:

   • Chronic pelvic pain
   • Dyspareunia (painful intercourse)
   • Persistent urinary symptoms 1

3. Malposition: Even intact slings can cause pain if positioned incorrectly

Warning Signs of Sling Complications

Be alert for these symptoms that may indicate sling breakage or erosion:

• Persistent dysuria (painful urination)
• Recurrent urinary tract infections
• Hematuria (blood in urine)
• Chronic pelvic pain
• Voiding difficulties
• Abnormal vaginal discharge
• Persistent urinary leakage 2, 3

Diagnostic Approach

When sling complications are suspected:

1. Cystoscopy: Essential for visualizing erosion into bladder/urethra
2. Imaging: Plain X-rays can identify calculi formation on exposed mesh material 3
3. Urodynamic testing: To assess impact on bladder function

Management Options

Treatment depends on the specific complication:

1. For urethral erosion:

   • Partial sling removal with urethral repair (86% of cases require formal repair) 1
   • May require indwelling catheter during healing

2. For bladder erosion:

   • Cystoscopy with cystolithopaxy for stone removal
   • Transurethral resection of visible mesh
   • Some cases require multiple procedures 3

3. For persistent pain without visible erosion:

   • Laparoscopic approach for sling removal is effective with minimal invasiveness
   • Average operating time: 104 minutes
   • Average hospital stay: <23 hours 4

Important Considerations

1. Recurrent incontinence risk: Most patients (71%) who undergo sling removal for complications will experience recurrence of stress urinary incontinence 1

2. Persistent symptoms: Even after sling removal, 80% of patients may continue to have urgency and frequency symptoms 4

3. Alternative treatments: For recurrent incontinence after sling removal:

   • Periurethral injections with bulking agents
   • Electrical stimulation of pelvic floor muscles 2

Prevention and Risk Reduction

The AUA/GURS/SUFU guidelines emphasize:

1. Proper patient selection: Consider individual risk factors before sling placement 5

2. Surgical technique: Mandatory cystoscopy during sling placement to identify immediate perforations 3

3. Post-operative vigilance: Early recognition of complications improves outcomes 5

Remember that unrecognized sling complications can lead to significant morbidity with medico-legal consequences, so maintain a high index of suspicion in patients with persistent urinary symptoms after sling placement 3.