Abstract
Introduction and hypothesis
Urethral complications due to synthetic midurethral slings are rare. Possible causes may include unrecognized trocar injury, mesh implantation despite recognized injury, mesh contamination leading to inflammation and delayed perforation, and excessive sling tension. There is no consensus as to the surgical management of urethral complications with regard to how much mesh should be excised, whether an interposition flap should be used, and whether a pubovaginal sling should be placed at the time of surgery. The purpose of this video is to present a technique of repairing complete urethral disruption due to a synthetic midurethral sling complication.
Methods
In this video, we demonstrate the steps to perform primary end-to-end urethral reconstruction for repairing complete urethral disruption. Any residual synthetic mesh must first be excised, after which the anastomosis may be completed.
Results
Complete urethral disruption is a rare complication of synthetic midurethral sling surgery that can be repaired primarily with good results.
Conclusions
There is no consensus regarding surgical management of urethral complications caused by synthetic midurethral slings, and thus an individualized approach should be used based on patient presentation and surgeon expertise.
References
Brubaker L, Norton PA, Albo ME (2011) 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 205(5):498.e1–6
Amundsen CL, Flynn BJ, Webster GD (2003) Urethral erosion after synthetic and nonsynthetic pubovaginal slings: Difference in management and continence outcome. J Urol 170:134–137
Shah K, Nikolavsky D, Gilsdorf D et al (2013) Surgical management of lower urinary mesh perforation after midurethral polypropylene mesh sling: mesh excision, urinary tract reconstruction and concomitant pubovaginal sling with autologous rectus fascia. Int Urogynecol J 24(12):2111–2117
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Abraham, N., Quirouet, A. & Vasavada, S. Repair of complete urethral disruption due to synthetic sling complication. Int Urogynecol J 25, 1279–1280 (2014). https://doi.org/10.1007/s00192-014-2416-8
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DOI: https://doi.org/10.1007/s00192-014-2416-8