Endoscopic Holmium Laser Excision of Intravesical Tension-Free Vaginal Tape and Polypropylene Suture After Anti-Incontinence Procedures

Giri, Subhasis; Drumm, John; Flood, Hugh D.

doi:10.1097/01.ju.0000173926.04596.55

Cited by 53 publications

(46 citation statements)

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“…Several authors have described their approach to this difficult problem (Table 2) [7,11,[18][19][20][21][22] and the approach remains guided by the locally available expertise. For intravesical tape and attendant bladder stone, an open cystotomy may be performed [14,21,[23][24][25].…”

Section: Discussionmentioning

confidence: 99%

“…[21] Intravesical Endoscopic resection assisted by instruments passed via a 5-mm suprapubic laparoscopic port Giri et al . [11] Intravesical Endoscopically using a Holmium laser to cut the tape Deng et al . [7] Intraurethral Excised per vaginum with reconstruction McLennan et al .…”

Section: Discussionmentioning

confidence: 99%

“…Finally, with the potential of using a flexible cystoscope, Giri et al . [11] used a holmium laser to remove intravesical tape.…”

Section: Discussionmentioning

confidence: 99%

“…A thorough cystoscopy is therefore essential to identify subtle submucosal needle positioning. The bladder must be well distended with at least 250 mL of fluid [10] and some authors recommend the use of a 7 ° cystoscope [11].…”

Section: Discussionmentioning

confidence: 99%

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Unrecognized bladder perforation with mid‐urethral slings

2010

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Study Type – Therapy (case series) Level of Evidence 4OBJECTIVETo present a series of women with late presentation of mid‐urethral synthetic slings perforating the bladder and their management, this is rare but can lead to significant morbidity with medico‐legal consequences.PATIENTS AND METHODSWe retrospectively reviewed the case notes of nine women with urinary symptoms referred to our unit for further investigation after synthetic mid‐urethral sling placement.RESULTSThe women presented between 8 weeks and 18 months after initial sling placement. Eight patients underwent a tension‐free vaginal tape insertion via the retropubic route and one patient had an ‘outside‐in’ obturator sling with the I‐Stop device (CL Medical, Lyon, France). The frequencies of presenting symptoms were: dysuria in six; recurrent urinary tract infection in four; frequency and urgency in four and pelvic pain in two. Seven of the nine women developed bladder calculi on the exposed sling material, all of which were visible on plain X‐ray. In six women, perforations were present at more than one site; in three urethral perforation had occurred together with an anterolateral bladder injury and in the remaining three there was bilateral bladder perforation. Initial management included cystoscopy and cystolithopaxy followed by transurethral resection (TUR) of the visible prolene mesh into the detrusor muscle. One woman required two TURs to clear all the mesh. Two women required further open surgery to remove all of the remaining mesh, both for ongoing pelvic pain that resolved after revision surgery. All the women had resolution of symptoms but all had recurrent stress urinary incontinence after tape division/excision. We used a novel technique to remove intraurethral mesh using a nasal speculum urethrally and excising the tape under direct vision, where resection proved impossible due to poor endoscopic views, with significant risk of sphincter injury.CONCLUSIONSThe possibility of unrecognized tape perforation or erosion must be considered in women with persistent urinary symptoms, infection or pain after any form of mid‐urethral sling procedure. Bladder stones almost invariably develop if the exposed mesh has been present for >3 months. Most patients can be managed with endoscopic resection to remove all intravesical tape. Cystoscopy should remain a mandatory procedure together with any form of mid‐urethral sling placement but does not prevent unrecognized perforations in inexperienced hands.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…Finally, with the potential of using a flexible cystoscope, Giri et al . [11] used a holmium laser to remove intravesical tape.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Unrecognized bladder perforation with mid‐urethral slings

2010

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“…3,4 Various surgical techniques have been reported for mesh removal. [3][4][5][6] The most widely reported is the transurethral approach either using electrocautery for division/resection of the tape 7,8 or Holmium Laser [9][10][11][12] . This approach although minimally invasive has a high rate of incomplete mesh removal and recurrence of mesh exposure and symptoms.…”

Section: Introductionmentioning

confidence: 99%

Eroded Tape: A Case of an Early Vesicoscopy Rather Than Laser Melting

Grange

Kouriefs

Georgiades

et al. 2017

Urology

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word count: 238Manuscript word count: 1907 Conflict of interest / Financial DisclosureDudley Robinson received funding from Astellas Pharma, Pfizer, Allergan, Ferring, and SEP. Phillipe Grange received funding for research, lecturing, and/or advice or consultancies from Johnson & Johnson and Prosurgics. Linda Cardozo received funding for research, lecturing, and/or advice or consultancies from Astellas Pharma, AMS, Pfizer, and Allergan. She is a member of Global Advisory Board for Solifenancin, co-chairman of the European overactive bladder forum, principal investigator for the SUNRISE study, and speaker at satellite symposia for Astellas Pharma. She is also a member of the Global Advisory Board for Fesoterodine and participant in a multicentre research study. The other authors report no relevant financial interests. Results:We here report 5 cases referred to our team with tape erosions that were treated with vesicoscopic excision of the material and primary closure of the urothelial defect. The foreign material was completely removed in all cases and there is no recurrence at a median follow-up of 30 months. Conclusion:Vesicoscopic excision of bladder eroded foreign material is feasible and efficient. We recommend this technique to be considered as primary approach to tapes eroding into the bladder.

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