Abstract
Introduction and hypothesis
To demonstrate a novel technique for complete laparoscopic removal of a transobturator sling for mesh erosion involving a large area of the urethra and bladder neck, without the need for concomitant vaginal dissection.
Method
A 56-year-old woman had a transobturator sling inserted for stress urinary incontinence (SUI) in 2009. In 2017, 8 years following surgery, she experienced groin pain, exacerbated by exercise, and developed recurrent urinary tract infections with dysuria and urethral pain. A cystoscopy demonstrated mesh erosion from the midurethra to bladder neck with a 2-cm calculus formed around the mesh. After careful counselling and discussion at a multi-disciplinary meeting, a decision was made to proceed with laparoscopy with a view to remove the mesh completely. The mesh was removed from the points of erosion into the urethra through a total laparoscopic procedure. The patient made a good recovery with no ongoing pain or voiding difficulties.
Conclusion
Combined approaches for complete excision of transobturator slings, including bilateral inguinal dissection, are relatively morbid with prolonged recovery time and in most centres will require involvement of plastic surgeons. The laparoscopic approach not only allows for the mesh to be removed in total (including the intramural portion of the mesh), but also provides magnified views compared with open surgery and thus allows for better identification of planes and dissection. It also has the added benefit of avoiding vaginal incisions and therefore reducing the risk of fistula formation between the urethra/bladder and vagina.
References
Kershaw V, Nicholson R, Ballard P, Khunda A, Puthuraya S, Gouk E. Outcome of surgical management for midurethral sling complications: a multicentre retrospective cohort study. Int Urogynecol J. 2019.
Keltie K, Elneil S, Monga A, Patrick H, Powell J, Campbell B, et al. Complications following vaginal mesh procedures for stress urinary incontinence: an 8 year study of 92,246 women. Sci Rep. 2017;7(1):12015.
Goodall EJ, Cartwright R, Stratta EC, Jackson SR, Price N. Outcomes after laparoscopic removal of retropubic midurethral slings for chronic pain. Int Urogynecol J. 2019;30(8):1323–8.
Gurol-Urganci I, Geary RS, Mamza JB, Duckett J, El-Hamamsy D, Dolan L, et al. Long-term rate of mesh sling removal following Midurethral mesh sling insertion among women with stress urinary incontinence. JAMA. 2018;320(16):1659–69.
Shah HN, Badlani GH. Mesh complications in female pelvic floor reconstructive surgery and their management: a systematic review. Int Urogynecol J. 2012;28(2):129.
Murphy AM, Goldman HB. Thigh exploration for excision of a transobturator sling. Int Urogynecol J. 2017;28(5):793–4.
Greenwell T, Cutner A. The anatomy and an illustrated description of a technique for combined laparoscopic and vaginal total removal of an obturator mid urethral tape. Transl Androl Urol. 2018;7(6):978–81.
Robinson D, Thiagamoorthy G, Ford A, Araklitis G, Giarenis I, Cardozo L. Does assessing urethral function allow the selection of the optimal therapy for recurrent SUI? Report from the ICI-RS 2017. Neurourol Urodyn. 2018;37(S4):S69–74.
Karim SS, Pietropaolo A, Skolarikos A, Aboumarzouk O, Kallidonis P, Tailly T, et al. 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. Int Urogynecol J. 2019.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare no conflict of interest.
Additional information
Consent
Written informed consent was obtained from the patient for publication of this video article and any accompanying images.
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic supplementary material
(MP4 61,387 kb)
Rights and permissions
About this article
Cite this article
Siddharth, A., Hussain, M.J., Cartwright, R. et al. A novel technique for complete laparoscopic excision of a transobturator sling with lower urinary tract mesh erosion. Int Urogynecol J 31, 839–841 (2020). https://doi.org/10.1007/s00192-020-04264-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00192-020-04264-x