Transvaginal sling excision: tips and tricks

  • 424 Accesses


Introduction and hypothesis

Complications of synthetic midurethral sling surgery include bladder outlet obstruction, mesh extrusion, and vaginal pain. A treatment of these complications is transvaginal mesh removal. The objectives of this video are to present cases of complications after sling placement and describe techniques to help with successful sling removal.


Three patients are presented in this video. One experienced urinary hesitancy and was found to have bladder outlet obstruction on urodynamic study. The second patient presented to the clinic with diminished force of stream and significant dyspareunia. The last patient presented with mesh extrusion. After discussion of management options, all three patients wished to pursue transvaginal sling excision.


All patients had successful removal of a portion of their synthetic midurethral sling. This video presents techniques to aide with dissection, mesh excision and prevention of further mesh complications. These include using an individualized surgical technique based on patient presentation and surgeon expertise, planning surgical incisions based on where mesh can be identified or palpated, using a cystoscope sheath or urethral dilator to identify any bladder outlet obstruction, and using a knife blade to identify mesh from surrounding tissue.


Sling excision can be successfully performed with careful surgical technique and dissection.

This is a preview of subscription content, log in to check access.

Access options

Buy single article

Instant unlimited access to the full article PDF.

US$ 39.95

Price includes VAT for USA

Subscribe to journal

Immediate online access to all issues from 2019. Subscription will auto renew annually.

US$ 199

This is the net price. Taxes to be calculated in checkout.


  1. 1.

    Nager C, Tulikangas P, Milder D, Rovner E, Goldman HB. Position statement on mesh midurethral slings for stress urinary incontinence. Female Pelvic Med Reconstr Surg. 2014;20:123–5.

  2. 2.

    Jonsson Funk M, Siddiqui NY, Pate V, Amundsen CL, Wu JM. Sling revision/removal for mesh erosion and urinary retention: long-term risk and predictors. Am J Obstet Gynecol. 2013;208:73.e1–7.

  3. 3.

    Osborn DJ, Dmochowski RR, Harris CJ, et al. Analysis of patient and technical factors associated with midurethral sling mesh exposure and perforation. Int J Urol. 2014;11:1167–70.

  4. 4.

    Brubaker L, Norton PA, Albo ME, et al. Adverse events over two years after retropubic or transobturator midurethral sling surgery: findings from the trial of midurethral slings (TOMUS) study. Am J Obstet Gynecol. 2011;205:498.e1–6.

  5. 5.

    Abbott S, Unger CA, Evans JM, et al. Evaluation and management of complications from synthetic mesh after pelvic reconstructive surgery: a multicenter study. Am J Obstet Gynecol. 2014;210:163.e1–8.

  6. 6.

    Welk B, Al-Hothi H, Winick-Ng J. Removal or revision of vaginal mesh used for the treatment of stress urinary incontinence. JAMA Surg. 2015;150:1167–75.

  7. 7.

    Clifton MM, Linder BJ, Lightner DJ, Elliott DS. Risk of repeat anti-incontinence surgery following sling release: a review of 93 cases. J Urol. 2014;191:710–4.

Download references

Author information

Correspondence to Marisa M. Clifton.

Ethics declarations

Conflicts of interest


Support/Financial disclosures

Neither Dr Clifton nor Dr Goldman has any financial disclosures.


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

Electronic supplementary material

Below is the link to the electronic supplementary material.

(MP4 50962 kb)


(MP4 50962 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Clifton, M.M., Goldman, H.B. Transvaginal sling excision: tips and tricks. Int Urogynecol J 28, 155–156 (2017).

Download citation


  • Suburethral sling
  • Urethra, surgical mesh
  • Foreign-body migration
  • Vaginal surgery