Retrospective study on the management and follow-up of 18 patients with a mid-urethral sling penetrating the urethra or bladder

Goujon, Edouard; Jarniat, Adélaide; Bardet, F.; Bergogne, Lise; Delorme, E.

doi:10.1016/j.jogoh.2018.05.007

Cited by 6 publications

(10 citation statements)

References 48 publications

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“…The median time of presentation after surgery was 34 months, and a low index of suspicion is necessary in these patients with a previous history of incontinence-related procedures. This delay in presentation can be due to vague non-specific symptoms and a lack of standardized follow-up [29]. A high index of suspicion is often needed, and a detailed evaluation is necessary often with a cystoscopy to examine the LUT, which can help to confirm the diagnosis.…”

Section: Outcomes With Practical Considerations Related To Mesh Erosionmentioning

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: Outcomes With Practical Considerations Related To Mesh Erosionmentioning

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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“…Various vaginal and abdominal surgical procedures are discussed in the literature, whereby vaginal procedures are prioritised. The vaginal interposition of a Martius flap as a defect coverage has proven itself here to be an efficient method with low morbidity 3 , 8 , 9 , 10 , 11 , 12 , 13 . In our investigation, only urethral reconstruction using a double-row, tension-free rows of simple interrupted sutures was performed in the case of smaller defects.…”

Section: Discussionmentioning

confidence: 99%

“…Verschiedene vaginale und abdominale operative Verfahren werden in der Literatur diskutiert, wobei vaginale Verfahren priorisiert werden. Die vaginale Interposition eines Martius-Flaps als Defektdeckung hat sich hier als effiziente Methode mit geringer Morbidität erwiesen 3 , 8 , 9 , 10 , 11 , 12 , 13 . In unserer Untersuchung wurde bei kleineren Defekten ausschließlich die Urethrarekonstruktion mittels zweireihiger spaannungsfreier Nahtreihen von Einzelknopfnähten durchgeführt.…”

Section: Diskussionunclassified

“…While iatrogenic accidental bladder perforations are described in 4% of cases, intraoperative injuries of the urethra, at 0.5%, appear to be far more rare 2 . Postoperative tape erosions in the bladder are described in 0.5 – 0.6% of cases and in the urethra in 0.007 – 1.5% of cases 3 , 4 . However the erosion of the tape in the urethra or the accidental iatrogenic transurethral tape position as well as necessary revision surgeries, such as in terms of a secondary tape transection in the case of bladder voiding dysfunction, can result in a urethrovaginal or vesicovaginal fistula formation 5 , 6 .…”

Section: Introductionmentioning

confidence: 99%

“…Während iatrogene akzidentielle Blasenperforationen mit 4% beschieben werden, erscheinen intraoperative Verletzungen der Urethra mit 0,5% deutlich seltener 2 . Postoperative Banderosionen in die Blase werden mit 0,5 – 0,6% und in die Urethra mit 0,007 – 1,5% beschrieben 3 , 4 . Allerdings können die Erosion des Bandes in die Urethra oder die iatrogen akzidentiell verursachte transurethrale Bandlage sowie notwendige Revisionsoperationen z.…”

Section: Introductionunclassified

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Management of Urethral Lesions and Urethrovaginal Fistula Formation Following Placement of a Tension-Free Suburethral Sling: Evaluation From a University Continence and Pelvic Floor Centre

Schöller

Brucker

Reisenauer

2018

Geburtshilfe Frauenheilkd

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Introduction The complication of tape erosion in the urethra following placement of a retropubic (TVT) or transobturator (TOT) tension-free suburethral vaginal sling or an accidental iatrogenic transurethral tape position can result in the formation of a urethrovaginal or vesicovaginal fistula. The objective of the investigation is the evaluation of the management of such rare complications. Patients and Methods Retrospective analysis of 14 patients who were treated for a urethral lesion or urethrovaginal fistula formation status post TVT/TOT placement between June 2011 and February 2018 in the Tübingen University Department of Gynaecology. Results As surgical therapy, 57.1% (n = 8) cases underwent vaginal fistula closure using a Martius flap of the labium majus and in 21.4% (n = 3) using a vaginal rotation skin flap. In 21.4% (n = 3), exclusively vaginal suture reconstruction of the urethra following excision of the tape running transurethrally or tape erosion was performed. 50% (n = 7) of the patients had lasting continence postoperatively without any further need for therapy. In 28.6% (n = 4), there was ongoing stress urinary incontinence, in 21.4% (n = 3) mixed urinary incontinence. Six of the 7 patients with persistent incontinence underwent new placement of a tension-free suburethral retropubic sling (TVT) an average of 8.8 months (5 – 13 months) postoperatively which was uncomplicated in all patients and achieved satisfactory continence. The 3 patients with mixed urinary incontinence and persistent urgency components additionally received anticholinergic medication. During the time period investigated, there were no long-term complications, in particular no recurrent fistulas. Conclusion The rare but relevant complications of a urethral erosion, transurethral tape position or urethrovaginal fistula formation status post TVT/TOT placement can be successfully managed via vaginal surgery. Persistent postoperative urinary incontinence with the need for a two-phase repeat TVT placement following sufficient wound healing must be preoperatively clarified.

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FIGO recommendations: Use of midurethral slings for the treatment of stress urinary incontinence

Lau

Davila

Chen

et al. 2023

Intl J Gynecology & Obste

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Background: Stress urinary incontinence (SUI) is a global problem. It can significantly adversely impact a woman's quality of life. The use of synthetic mesh in vaginal surgery is controversial, especially when used for pelvic organ prolapse surgery. Although negative effects have been reported, the synthetic mesh midurethral sling (MUS) is considered to be safe and effective in the surgical treatment of SUI.Objectives: To provide evidence-based data and recommendations for the obstetrician/gynecologist who treats women with SUI and performs or plans to perform MUS procedures. Methods: Academic searches of MEDLINE, the Cochrane Library, Embase, and Google Scholar articles published between 1987 and March 2020 were performed by a subgroup of the Urogynecology and Pelvic Floor Committee, International Federation of Gynecology and Obstetrics (FIGO).Selection Criteria: The obtained scientific data were associated with a level of evidence according to the Oxford University Centre for Evidence-Based Medicine and GRADE Working Group system. In the absence of concrete scientific evidence, the recommendations were made via professional consensus. Results:The FIGO Urogynecology and Pelvic Floor Committee reviewed the literature and prepared this evidence-based recommendations document for the use of MUS for women with SUI.Conclusions: Despite the extensive literature, there is a lack of consensus in the optimal surgical treatment of SUI. These recommendations provide a direction for surgeons to make appropriate decisions regarding management of SUI. The MUS is considered safe and effective in the treatment of SUI, based on many high-quality scientific publications and professional society recommendations. Comprehensive long-term data and systemic reviews are still needed, and these data will become increasingly important as women live longer. These recommendations will be continuously updated through future literature reviews.

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Retrospective study on the management and follow-up of 18 patients with a mid-urethral sling penetrating the urethra or bladder

Cited by 6 publications

References 48 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

Management of Urethral Lesions and Urethrovaginal Fistula Formation Following Placement of a Tension-Free Suburethral Sling: Evaluation From a University Continence and Pelvic Floor Centre

FIGO recommendations: Use of midurethral slings for the treatment of stress urinary incontinence

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