Endoscopic Treatment of Vesical and Urethral Perforations After Tension-Free Vaginal Tape (Tvt®) Procedure for Female Stress Urinary Incontinence

Abstract

Stress urinary incontinence is a problem that is prevalent in women, and its treatment with minimally invasive techniques using synthetic materials has increased recently, although the procedure has also brought increased occurrence of specific complications such as vesical and urethral perforations. We describe 11 cases of endoscopic correction of vesical and urethral perforations due to the use of synthetic material for the treatment of stress urinary incontinence. MATERIALS AND METHOD: Eleven patients were treated for complications after undergoing the TVT ® (tension-free vaginal tape) procedure; 6 of them had the polypropylene tape inside the bladder, and 5 had erosion of the urethra. Endoscopic resection of the polypropylene tapes was performed on all patients. RESULTS: A 6-month follow-up with cystoscopic control showed that the procedures were successful with complete relief of the symptoms except for 1 patient who persisted with the polypropylene tape in the bladder. This patient underwent a new endoscopic resection, and the cystoscopic control exam was normal 3 months later. CONCLUSION: Endoscopic resection of intravesical and intraurethral synthetic tapes can be considered a good alternative for the treatment of complications resulting from the TVT procedure.

Management of iatrogenic foreign bodies of the bladder and urethra following pelvic floor surgery

“…10 Others have reported more positive outcomes for endoscopic mesh removal using more complicated techniques. 11,12 Success in 10 of 11 patients with transvaginal tape erosion in the bladder or urethra with endoscopic approaches was reported by Baracat and colleagues. 12 In their cases of urethral tape erosion, a rigid nephroscope (26 Fr) was introduced into the urethra; 5 mm laparoscopic scissors were introduced in the working port of the nephroscope, and the tapes withdrawn from the interior of the bladder or of the urethra.…”

“…11,12 Success in 10 of 11 patients with transvaginal tape erosion in the bladder or urethra with endoscopic approaches was reported by Baracat and colleagues. 12 In their cases of urethral tape erosion, a rigid nephroscope (26 Fr) was introduced into the urethra; 5 mm laparoscopic scissors were introduced in the working port of the nephroscope, and the tapes withdrawn from the interior of the bladder or of the urethra. In the cases of intravesical tapes, a 5 mm laparoscopic trocar was introduced suprapubically, followed by laparoscopic Maryland tweezers for fixation and traction of the tape inside the bladder.…”

Tension Free Vaginal Tape Erosion into the Urinary Bladder: A Case Report

“…The use of minimally invasive procedures using synthetic material for the treatment of SUI can cause specific complications that are uncommon with native tissue repair [5]. Urethral and bladder erosion usually present with hematuria, frequency, urgency, urethral or vaginal pain or recurrent urinary tract infections [6,7].…”

1346 Outcomes of Transurethral Removal of Intravesical or Intraurethral Mesh Following Midurethral Sling Surgery

“…A factor requiring deep resection is the difficulty in allowing tension to the mesh. Two groups reported a combined endoscopic laparoscopic tape removal method [8,15]. In this method, a laparoscopic trocar was inserted suprapubically into the bladder under cystoscopic control.…”

“…Since the first case of urethral mesh erosion was reported in 2001, several case series have provided various techniques to manage this difficult complication [7,[8][9][10]. Intravesical or intraurethral mesh can be removed by open surgery (cystorrhapy or urethrolysis and urethroplasty) or endoscopic surgery.…”