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

Jo, Dae-Jin; Lee, Young-Suk; Oh, Tae Hee; Ryu, Dongsu; Kwak, Kyung Won

doi:10.4111/kju.2011.52.12.829

Cited by 22 publications

(16 citation statements)

References 21 publications

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“…Over the last 2 decades the treatment of stress urinary incontinence (SUI) has shifted to a midurethral sling (MUS) or a mesh-based bladder neck procedure [1]. Although the surgery was believed to be relatively safe, there has been a steep rise in the number of reported cases of their erosion into the lower urinary tract [2][3][4][5][6][7][8][9][10]. Mesh erosion was first reported in 2001 but is now recognized as a major long-term complication of MUS surgery with an incidence rate of between 0.6 and 5.4% [2,11].…”

Section: Introductionmentioning

confidence: 99%

Role of endoscopic management in synthetic sling/mesh erosion following previous incontinence surgery: a systematic review from European Association of Urologists Young Academic Urologists (YAU) and Uro-technology (ESUT) groups

et al. 2019

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Introduction and hypothesis Foreign body (FB) erosion is now recognized as a major long-term complication following previous incontinence surgery. The aim of our systematic review was to ascertain the outcomes of endoscopic management in synthetic sling/mesh erosion following previous gynaecological surgery. Methods A systematic review in line with PRISMA and Cochrane guidelines was conducted for all English language articles between 1996 and December 2018 for all articles reporting on endoscopic surgical management for eroded FB following previous sling/mesh procedure for incontinence. Results Our search produced 931 articles of which 20 articles (198 patients) were included in our review; 149 (75%) had tensionfree vaginal tapes (TVT) or tension-free obturator tapes (TOT) as their initial procedure. The site of mesh erosion was the bladder in 134 patients (68%) of which 12 (6%) were in the bladder neck. Urethral mesh erosion was seen in 63 patients (32%) across all studies.The treatment of eroded mesh was by laser and endoscopic excision using an electrode loop or laparoscopic scissors in 108 (55%) and 90 (45%) patients respectively. The initial/final success rate with laser and endoscopic excision was 67%/92% and 80%/98% respectively. The overall complication rates were 24% and 28% in laser and endoscopic groups respectively of which 21% in each group were stress urinary incontinence. Conclusions Endoscopic management of FB erosion is an effective minimally invasive technique with good outcomes and minimal morbidity. Management with the use of holmium laser is gaining momentum and could be attempted before open surgical removal. There is a need for comparative data between open surgical excision and endoscopic excision to help better describe the patient's most likely to benefit from the endoscopic technique.

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Section: Introductionmentioning

confidence: 99%

Role of endoscopic management in synthetic sling/mesh erosion following previous incontinence surgery: a systematic review from European Association of Urologists Young Academic Urologists (YAU) and Uro-technology (ESUT) groups

et al. 2019

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“…TUR-E was successful in 93.7 % of patients with only one recurrence of mesh erosion, and success was not affected by location of the mesh in the urethra or bladder. However, a vesicovaginal fistula developed in two patients, and bladder perforation is also a risk with TUR-E, which may require extended catheterization [11]. In comparison, we found a symptomatic success rate of 80 % with TEEH and anatomic success in 67 % overall and in 80 % of those with bladder erosions.…”

Section: Discussionmentioning

confidence: 61%

Holmium laser excision for urinary mesh erosion: a minimally invasive treatment with favorable long-term results

2015

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“…These patients may present with multiple symptoms, including dysuria, hematuria, and irritative or obstructive urinary symptoms after surgery. 7 Bladder injuries should be considered in patients presenting with such symptoms, even if needleless surgery was performed. The use of cystoscopy in such cases is useful to confirm the perforation diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Rare complication of needleless mini-sling procedure: Case report

Karalar

Keleş

Ünlü

et al. 2017

CUAJ

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The mini-sling procedure is a widely used, minimally invasive treatment for stress urinary incontinence. While bladder perforation and stone formation over the mesh is not an expected complication of the mini-sling procedure, in this case, we report on the management of bladder calculi formed over the mesh, which was passed through the bladder while applying the mini-sling procedure, and was eventually removed using holmium laser. Performing cystoscopy in patients with irritative and obstructive symptoms after the sling procedure will help confirm bladder perforation, and an endoscopic approach using holmium laser is an effective treatment. IntroductionStress urinary incontinence (SUI) is a common health problem. Conservative techniques, as well as pharmacological and surgical approaches, are used in the treatment of SUI. 1The aim of surgery is to correct the deficient urethral closure and to prevent incontinence.Ulmsten et al described a minimally invasive technique, a tension-free vaginal tape (TVT) for SUI, in 1996 and it has become the gold standard procedure.2 In 2001, Delorme et al described the transobturator tape implantation (TOT) method to avoid the risk of bladder and bowel perforation and major vascular injuries that can occur with TVT; 3 however, similar complications were observed.1 In 2006, a thirdgeneration of midurethral tapes -known as single-incision mini-slings -was introduced to reduce complications such as bladder perforation.1 The mini-sling procedure is a widely used, minimally invasive treatment for SUI; there are only a few reports on its complications. 4 Bladder perforation and stone formation over the mesh are not expected complications of mini-sling procedures. Further, the technique of removing an eroded tape from the bladder remains controversial. 6 In this case, we report on the management of bladder calculi formed over the mesh, which was passed through the bladder while applying the mini-sling procedure, and removed using holmium laser. Case reportA 46-year-old woman was admitted to our urology clinic for pelvic pain, dysuria, recurrent urinary tract infections, urinary frequency, and urgency. She had a history of stress urinary incontinence, which had been treated with a minisling procedure using a needleless device. The procedure had been performed at a different hospital four months prior and her complaints began after the procedure. Her urine examination demonstrated pyuria and microscopic hematuria. Extended-spectrum β-lactamase-producing (ESBL) Escherichia coli was detected in her urine culture and appropriate antibiotherapy was given. A 25 x 15 mm opacity at bony pelvis was observed on her plain X-ray radiography of the abdomen and a 3 x 2 cm bladder stone was seen on ultrasound (Fig. 1). With these findings, cystoscopy was performed under spinal anesthesia. A stone surrounding the polypropylene mesh at the right base of the bladder wall was observed. Stone over the mesh was fragmented using both holmium-YAG laser (Sphinx ® LISA laser, 80 W, 2120 nm, 0.5-4.5 J) an...

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

Cited by 22 publications

References 21 publications

Role of endoscopic management in synthetic sling/mesh erosion following previous incontinence surgery: a systematic review from European Association of Urologists Young Academic Urologists (YAU) and Uro-technology (ESUT) groups

Role of endoscopic management in synthetic sling/mesh erosion following previous incontinence surgery: a systematic review from European Association of Urologists Young Academic Urologists (YAU) and Uro-technology (ESUT) groups

Holmium laser excision for urinary mesh erosion: a minimally invasive treatment with favorable long-term results

Rare complication of needleless mini-sling procedure: Case report

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