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A novel combined transurethral and suprapubic approach for excision of mesh at the bladder neck

  • Gabriel N. SchaerEmail author
  • Tilmann Moeltgen
  • Gloria Ryu
  • Heimo Magg
  • Zaraq Khan
  • Dimitri Sarlos
IUJ Video

Abstract

Introduction and hypothesis

Unrecognized bladder perforation of a tension-free sling is a rare situation. Removal of the intravesical sling has been done by laparotomy or transurethrally. With technique presented here we want to show a minimally invasive approach that allows complete removal of the intraluminal sling material, located at the bladder neck.

Methods

This video shows a novel combined transurethral and suprapubic approach for radical removal of the mesh. Two 3.5-mm trocars were placed suprapubically into a filled bladder. One site was used for an optic with camera and the other for a 3.5-mm grasping forceps to apply tension on the mesh to pull it out of the bladder wall while it was being excised transurethrally with a cystoscope and transurethral scissors.

Results

The patient’s postoperative course was uneventful. At 1-month follow-up, the patient was free of dysuria and cystoscopy revealed complete healing of the mesh site. Because of recurrent stress urinary incontinence, another continence sling surgery has been performed (TVT exact). After a follow-up of 2 years, she is continent and free of dysuria.

Conclusions

This novel technique provides an effective means of removing mesh perforated into the bladder, located at the bladder neck, using a combined transurethral and suprapubic approach. The technique is minimally invasive and the applied traction allows complete removal of the intraluminal part of the mesh.

Keywords

Tension-free vaginal tape Complication Bladder perforation Mesh removal Minimally invasive 

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 87539 kb)

References

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Copyright information

© The International Urogynecological Association 2019

Authors and Affiliations

  1. 1.Department of Obstetrics and GynecologyKantonsspital AarauAarauSwitzerland
  2. 2.Department of UrologyKantonsspital AarauAarauSwitzerland
  3. 3.Department of Obstetrics and GynecologyMayo ClinicRochesterUSA

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