Pediatric urology

Abstract

Urological Survey review was performed to retrieve data on safety and efficacy, complications and outcomes using this product. Results: Six patients (17%) to date have presented with defective vaginal healing manifested by extrusion of the sling material. Mean time to presenting symptoms was 9 months (range 2 to 15). All patients required surgical removal of the sling material. No urethral erosions were noted. Conclusions: Our experience suggests that the IVS sling system, which uses a multi-filament polypropylene suburethral mesh, incurs an unacceptably high rate of defective vaginal wound healing and mesh extrusion. Editorial Comment The authors reviewed a total of 35 patients who underwent a suburethral sling procedure using the intravaginal slingplasty (IVS) tension free vaginal tape. This is a multifilament polypropylene tape used for a mid-urethral sling technique. The authors noted a 17% sling extrusion rate with the mean time to presentation being approximately 9 months. All the patients required surgical removal of the sling material. The causes of mesh erosion may be potentially multi-factorial: tension of sling, tissue vascularity, material composition and weave. Symptom presentation is variable and includes vaginal bleeding or discharge, pelvic pain as well as dysparunia and malodor. Though some have discussed minimally invasive techniques of managing vaginal erosion (1) most authors advocate partial or complete excision of the surgical material. As the trend toward suburethral slings continues towards increasing degree of minimal invasiveness, surgeons must always remember that minimal invasiveness does not always mean minimal complications. Scientific research to help analyze the causes of erosion to help minimize this complication should continue as changing demographics combined with patient demand will lead to increased performance of minimally invasive anti-incontinence procedures using artificial material.