Three-year outcomes of tension-releasing suture (TRS) modification in single-incision Solyx™ sling: Ultrasonographic and clinical assessment of postoperative voiding dysfunction

The mid-urethral sling (MUS) is a safe and effective treatment for stress urinary incontinence (SUI), however it can produce voiding dysfunction in 2–4% of patients, typically due to over-tensioning. Sling lysis and/or mobilization can help, but it needs additional surgery and costs. The tension-releasing suture (TRS) (i.e., a bedside maneuver to loosen the sling in the immediate post-operative period) can overcome such difficulties and has previously been described with a 92% objective and subjective cure rate. The study seeks to evaluate the mid-term effectiveness of TRS after installing the Solyx™ MUS over a three-year follow-up. The secondary goal is to demonstrate functionality and position using introital ultrasonography (US). Retrospective case-series study conducted at a tertiary referral facility from September 2015 to December 2020. 18 patients experienced voiding dysfunction following anti-incontinence surgery. Primary outcome was objective and subjective cure. Secondary outcomes included quality of life (QoL) and ultrasonography assessments. US was done six months and three years following the procedure. Objective cure rate was 94.1%, and the subjective rate was 88.2% with only 17 were included in the final analysis, QoL also showed improvement at third year. As shown in the US results, the bladder neck position and mobility remained consistent. The percentages of mid-point sling position and urethral kinking were consistent, showing that the sling was appropriately positioned and did not migrate after surgery. TRS manipulation after Solyx™ surgery is safe and effective modality to treat post-operative voiding dysfunction. Furthermore, the tape position was constant with no dislodging noted after three years.