# Unilateral J‐cut division versus partial and subtotal removal techniques in female patients with mesh‐related urethral obstruction: Multicentric comparative study

## TL;DR

This study compares three surgical techniques for treating mesh-related urethral obstruction in women, finding that one method is as effective but faster and safer.

## Contribution

The study provides a multicenter comparison of unilateral J-cut division versus partial and subtotal removal techniques for mesh-related urethral obstruction.

## Key findings

- Unilateral J-cut division had shorter surgery time compared to partial and subtotal removal techniques.
- De novo stress urinary incontinence occurred less frequently with unilateral J-cut division.
- All techniques improved urine flow and reduced residual urine volume.

## Abstract

To compare the functional (obstruction relieving) outcomes and complications of unilateral J‐cut division, partial and subtotal vaginal removal techniques were performed for mesh‐related urethral obstruction (MRUO) in females.

Patient review included demographics, a medical history and proforma with details of lower urinary tract symptoms (LUTS), physical and urodynamic findings, detailed surgical reports and follow‐up data. Variables were compared between the three groups.

Out of 130 patients with sling revision surgery (SRS), 54 women underwent SRS for MRUO with a median follow‐up of 48 (17–96) months. Unilateral J‐cut division, partial and subtotal vaginal removal techniques were performed in 12, 31 and 11 patients with a median duration of surgery of 30 (25–34), 40 (35–56) and 60 (60–70) minutes, respectively (p = 0.001). Statistically significant increase in median maximum free urine flow rate and decrease in median post‐void residual urine volume were found after SRS in the three groups, while de novo stress urinary incontinence (SUI) developed in 10%, 44% and 60% of the patients in the unilateral J‐cut division, partial and subtotal removal groups, respectively (p = 0.007).

The unilateral J‐cut division technique was as effective as the partial and subtotal vaginal removal techniques in relieving MRUO with a shorter duration of surgery time (p = 0.001) and lower risk of de novo SUI (p = 0.007). Comparative studies with a larger number of patients are needed.