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International Urogynecology Journal

, Volume 27, Issue 12, pp 1929–1931 | Cite as

Removal of obstructing synthetic sling from a urethra: English and Spanish version

  • Javier Pizarro-BerdichevskyEmail author
  • Michelle P. Goldman
  • Howard B. Goldman
IUJ Video
  • 242 Downloads

Abstract

Introduction and hypothesis

Urethral perforations after synthetic midurethral sling (MUS) placement are uncommon. Transvaginal removal is an option. The objective of this English and Spanish video is to demonstrate removal of an MUS that had perforated the urethra and the concomitant urethral reconstruction.

Methods

A 66-year-old woman with a history of an anterior and posterior colporrhaphy and a retropubic MUS 12 years earlier presented with difficulty voiding, recurrent urinary tract infections, and mild stress incontinence (SUI). Physical examination revealed tenderness on the anterior vaginal wall (AVW) without mesh extrusion. Cystourethroscopy showed urethral perforation, distal to the bladder neck and urodynamics demonstrated an obstructive pattern. The patient wished to undergo transvaginal sling removal and reconstruction.

Results

The mesh was deep in the AVW perforating the urethra and the vaginal portion was completely removed. The video demonstrates several tips on how to remove a perforating MUS and subsequent urethral reconstruction. Ten months postoperatively the force of stream returned to normal, with no further UTIs, no evidence of fistula, and rare SUI.

Conclusions

Urethral perforation with an MUS can be successfully treated with removal of any mesh in proximity to the urethra and urethral reconstruction via a completely transvaginal approach.

Keywords

Suburethral slings Urethra Surgical mesh Foreign-body migration Urinary incontinence Stress Vaginal surgery 

Notes

Compliance with ethical standards

Conflicts of interest

None.

Consent

Written informed consent was obtained from the patient for publication of this video article and any accompanying images.

Supplementary material

ESM 1

(MP4 347171 kb)

ESM 2

(MP4 138408 kb)

References

  1. 1.
    Novara G, Galfano A, Boscolo-Berto R, et al. Complication rates of tension-free midurethral slings in the treatment of female stress urinary incontinence: a systematic review and meta-analysis of randomized controlled trials comparing tension-free midurethral tapes to other surgical procedures and different devices. Eur Urol. 2008;53(2):288–308.CrossRefPubMedGoogle Scholar
  2. 2.
    Abed H, Rahn DD, Lowenstein L, Balk EM, Clemons JL, Rogers RG. Incidence and management of graft erosion, wound granulation, and dyspareunia following vaginal prolapse repair with graft materials: a systematic review. Int Urogynecol J. 2011;22(7):789–98.CrossRefPubMedGoogle Scholar
  3. 3.
    Freilich DA, Rovner ES. Removal of polypropylene sling mesh from the urethra: an anatomic technique. Urology. 2015;86(1):196–9.CrossRefPubMedGoogle Scholar
  4. 4.
    Werner M, Najjari L, Schuessler B. Transurethral resection of tension-free vaginal tape penetrating the urethra. Obstet Gynecol. 2003;102(5 Pt 1):1034–6.PubMedGoogle Scholar
  5. 5.
    Haylen BT, Freeman RM, Swift SE, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint terminology and classification of the complications related directly to the insertion of prostheses (meshes, implants, tapes) and grafts in female pelvic floor surgery. Int Urogynecol J. 2011;22(1):3–15.CrossRefPubMedGoogle Scholar
  6. 6.
    American College of Obstetricians and Gynecologists. ACOG Committee Opinion. Number 372. July 2007. The role of cystourethroscopy in the generalist obstetrician-gynecologist practice. Obstet Gynecol. 2007;110(1):221–4.CrossRefGoogle Scholar

Copyright information

© The International Urogynecological Association 2016

Authors and Affiliations

  1. 1.Urogynecology UnitSantiagoChile
  2. 2.Division Obstetricia y GinecologiaPontificia Universidad Católica de ChileSantiagoChile
  3. 3.Glickman Urologic and Kidney InstituteCleveland ClinicClevelandUSA

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