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Olive EJ, Linder BJ. Robotic-assisted intravesical mesh excision following retropubic midurethral sling. Int Urogynecol J 2024; 35:921-923. [PMID: 38308690 DOI: 10.1007/s00192-024-05736-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 01/06/2024] [Indexed: 02/05/2024]
Abstract
INTRODUCTION AND HYPOTHESIS Intravesical mesh is an uncommon complication following synthetic midurethral sling placement. Management options have included endoscopic techniques such as laser ablation or surgical excision. We present our technique for robotic-assisted excision of intravesical mesh following a retropubic midurethral sling. METHODS The patient is a 66-year-old woman with a remote history of laser ablation of intraurethral mesh after midurethral sling, and persistent symptomatic intravesical mesh with associated stone at the bladder neck and right bladder wall. Robotic excision of the intravesical mesh and stone was performed by entering the space of Retzius, carrying the dissection along the right arm of the retropubic sling, performing two cystotomies to free and remove the mesh, and finally closing the cystotomies in two layers. RESULTS The patient was discharged on postoperative day 1. A cystogram prior to catheter removal showed no extravasation and a competent bladder neck. She reported no new stress incontinence and had improvement in overactive bladder symptoms. CONCLUSIONS Robotic excision of intravesical mesh after synthetic midurethral sling was safely performed in this patient who had multiple areas of intravesical mesh. Management aspects reported here may be helpful for complex presentations of intravesical mesh.
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Affiliation(s)
| | - Brian J Linder
- Department of Urology, Mayo Clinic, Rochester, MN, USA.
- Division of Urogynecology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
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Okui N. The Potential of Non-ablative Erbium (YAG) Laser Treatment for Complications After Midurethral Sling Surgery: A Narrative Review. Cureus 2024; 16:e58486. [PMID: 38638175 PMCID: PMC11024877 DOI: 10.7759/cureus.58486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2024] [Indexed: 04/20/2024] Open
Abstract
Midurethral sling (MUS) surgery, using tension-free vaginal tape and transobturator tape, has been widely adopted for the treatment of stress urinary incontinence (SUI). However, postoperative complications, including persistent urinary incontinence, mesh exposure, and pain, have become problematic, and surgical treatments for these complications face challenges, such as invasiveness, treatment-resistant cases, and recurrence. This review provides an overview of the current evidence regarding these complications and the potential of vaginal non-ablative erbium (YAG) laser (VEL) treatment as a minimally invasive option with low risk of complications. Studies have suggested the effectiveness of VEL treatment, performed using devices such as IncontiLase (SP Dynamis; Fotona d.o.o., Ljubljana, Slovenia), for persistent urinary incontinence after MUS surgery, pain following mesh removal, and asymptomatic mesh exposure. VEL treatment is expected to be a new treatment option for complications following MUS surgery; however, further large-scale comparative trials are required to verify its efficacy and safety and to establish criteria for its indications. Appropriate assessment of the indications and provision of sufficient information to patients is important when presenting VEL as a treatment option.
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Affiliation(s)
- Nobuo Okui
- Dentistry, Kanagawa Dental University, Kanagawa, JPN
- Urology, Yokosuka Urogynecology and Urology Clinic, Kanagawa, JPN
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Carlson K, Andrews M, Bascom A, Baverstock R, Campeau L, Dumoulin C, Labossiere J, Locke J, Nadeau G, Welk B. 2024 Canadian Urological Association guideline: Female stress urinary incontinence. Can Urol Assoc J 2024; 18:83-102. [PMID: 38648655 PMCID: PMC11034962 DOI: 10.5489/cuaj.8751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Affiliation(s)
- Kevin Carlson
- Southern Alberta Institute of Urology & Section of Urology, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Matthew Andrews
- Division of Urology, Department of Surgery, Memorial University, St. John’s, NL, Canada
| | | | - Richard Baverstock
- Southern Alberta Institute of Urology & Section of Urology, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Lysanne Campeau
- Division of Urology, Department of Surgery, McGill University, Montreal, QC, Canada
| | | | - Joe Labossiere
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | | | - Geneviève Nadeau
- Division of Urology, Department of Surgery, Université Laval, Quebec, QC, Canada
| | - Blayne Welk
- Division of Urology, Department of Surgery, Western University, London, ON, Canada
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Carlton CE, Chen JY, Souders CP, Goueli R, Zimmern PE. Laser excision of urethral mesh erosion: a 10-year experience. World J Urol 2024; 42:125. [PMID: 38460045 DOI: 10.1007/s00345-024-04822-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 01/16/2024] [Indexed: 03/11/2024] Open
Abstract
PURPOSE To review our 10-year experience with laser excision for urethral mesh erosion (UME) of mid-urethral slings (MUS). METHODS Following Institutional Review Board approval, the charts of female patients with endoscopic laser excision of UME were retrospectively reviewed. Demographics, clinical presentation, surgical history, pre- and post-operative Urinary Distress Inventory-6 scores and quality of life ratings, operative reports, and outcomes were obtained from electronic medical records. UME cure was defined as no residual mesh on office cystourethroscopy 5-6 months after the final laser excision procedure. RESULTS From 2011 to 2021, 23 patients met study criteria; median age was 56 (range 44-79) years. Twenty (87%) had multiple prior urogynecologic procedures. Median time from MUS placement to presentation with UME-related complaints was 5.3 [interquartile range (IQR) 2.3-7.6] years. The most common presenting symptom was recurrent urinary tract infection (rUTI) (n = 10). Median operating time was 49 (IQR 37-80) minutes. Median duration of follow-up was 24 (IQR 12-84) months. Fourteen (61%) required more than 1 laser excision procedure for UME. Although 5 were asymptomatic (22%), new (n = 5) or persistent (n = 8) urinary incontinence was the most common symptom on follow-up (57%). CONCLUSION UME presenting symptoms are highly variable, necessitating a high index of suspicion in patients with a history of MUS, especially in the case of rUTI. Endoscopic laser excision is a minimally invasive, brief, safe, outpatient procedure with a high UME cure rate.
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Affiliation(s)
- Caitlin E Carlton
- Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9110, USA
| | - Jessie Y Chen
- Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9110, USA
| | - Colby P Souders
- Urologic Surgery, University of Kansas Medical Center, 4000 Cambridge Street, Kansas City, KS, 66160, USA
| | - Ramy Goueli
- Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9110, USA
| | - Philippe E Zimmern
- Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9110, USA.
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Ripa F, Enikeev D, Talyshinskii A, Juliebø-Jones P, Tzelves L, Kallidonis P, Somani B. Should endoscopic laser excision be offered as the first-line management for patients with eroded mesh? Outcomes of a systematic review of literature. Curr Opin Urol 2024; 34:135-144. [PMID: 37933676 DOI: 10.1097/mou.0000000000001146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
PURPOSE OF REVIEW Mesh erosions following previous synthetic sling/mesh surgery for stress urinary incontinence (SUI) have become increasingly common. This systematic review provides evidence for the role of laser excision as a first-line management in patients with eroded mesh. RECENT FINDINGS Fourteen articles (173 patients) were included for the final review. Among these, 138 patients (79.8%) were submitted to trans-urethral laser excision of eroded urethral/bladder mesh over a median time to presentation of 36.6 months. Over a median follow-up of 23.6 months, 88 (63.7%) reported a complete resolution, 32 (23.2%) reported persistence or recurrence of SUI and 17 (12.3%) presented with recurrent mesh erosion. The success rate after a single endoscopic procedure was 66.5, vs. 93.5% after additional endoscopic procedures, with only 9 (6.6%) requiring open surgical excision. Overall, there were seven (5.1%) postoperative complications including two urethrovaginal fistulas, two UTIs and haematuria each, and one case of urethral diverticulum. SUMMARY Laser excision of eroded mid-urethral slings into either the bladder or urethra is a challenging complication of minimally invasive incontinence surgery. Laser excision was able to achieve a good success rate with single or staged endoscopic procedure with a low risk of complication. It represents a valid first treatment option, although patients should be managed in mesh referral centres in collaboration with uro-gynaecology teams.
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Affiliation(s)
- Francesco Ripa
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Dmitry Enikeev
- Department of Urology, Medical University of Vienna, Vienna, Austria
- Urology Department, Rabin Medical Center, Petah Tikva, Israel
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Ali Talyshinskii
- Department of Urology, Astana Medical University, Astana, Kazakhstan
| | - Patrick Juliebø-Jones
- Department of Urology Haukeland and Department of Clinical Medicine, University Hospital, Bergen, Norway
| | - Lazaros Tzelves
- Department of Urology, University College of London Hospital, London, UK
| | | | - Bhaskar Somani
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Anderson K, Perrouin‐Verbe M, Bridgeman‐Rutledge L, Skews R, Hashim H. Cystoscopic removal of transvaginal mesh: Long-term outcomes. BJUI COMPASS 2023; 4:543-548. [PMID: 37636201 PMCID: PMC10447205 DOI: 10.1002/bco2.254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 05/07/2023] [Indexed: 08/29/2023] Open
Abstract
Objectives This study's aim is to evaluate the long-term quality of life and functional outcomes following cystoscopic excision of stress urinary incontinence (SUI) and pelvic organ prolapse (POP) mesh extruded into the urinary tract in women. Patients and Methods A retrospective chart review was performed of all cases of cystoscopic removal of extruded mesh at our high-volume tertiary care centre between April 2013 and August 2021. Postoperative patient-reported outcomes were collected via questionnaires: Urogenital Distress Inventory Short Form (UDI-6), EQ-5D-5L Visual analogue scale, ICIQ-Satisfaction (ICIQ-S) and additional questions regarding postoperative sexual function. Results During the study period, 27 women with a median age of 61 years (45-87) underwent cystoscopic mesh removal surgery using either Ho-YAG laser (56%) or bipolar loop resection (44%). The most common presentation of mesh extrusion was recurrent urinary tract infections (67%). Other presenting complaints were pain (41%), urinary urgency ± incontinence (41%) and voiding difficulties (18%). Long-term follow-up outcomes from 20 patients (median follow-up: 24 months) showed that mesh removal was rated successful by 80%, and 100% would choose to have the surgery again if in the same situation. Recurrent SUI was reported by 45% of respondents, and urinary urge incontinence was found in 50%. For patients who answered the sexual function questions, 50% reported improved sexual function postmesh removal (6/12). Conclusions Cystoscopic removal of extruded female SUI and POP mesh is associated with high patient satisfaction and low morbidity in appropriately selected patients at 2-year median follow-up. A patient-centred shared decision-making process is essential in counselling patients regarding options and expected outcomes following mesh removal surgery.
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Affiliation(s)
| | | | | | - Rachel Skews
- Bristol Urological Institute, Southmead HospitalBristolUK
| | - Hashim Hashim
- Bristol Urological Institute, Southmead HospitalBristolUK
- Bristol Medical SchoolUniversity of BristolBristolUK
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Bazinet A, Weis S, Madec FX, Boillot B. Management of iatrogenic urethral foreign body after mid-urethral sling A literature review. Can Urol Assoc J 2023; 17:E269-E280. [PMID: 37458745 PMCID: PMC10544405 DOI: 10.5489/cuaj.8293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
INTRODUCTION Urethral mesh perforation is a rare complication of mid-urethral sling resulting in a lack of clear management guidelines. Thus, we aimed to determine management options and their respective outcomes in terms of erosion resolution and continence. METHODS A literature review was performed by extracting studies from the PubMed, Cochrane, and Google Scholar from January 1996 to December 1, 2022. Only French and English language studies were included. A total of 227 papers were screened and assessed for eligibility. RESULTS Forty-eight studies were included in the final analysis, for a total of 224 patients. Treatment options consisted of conservative, endoscopic, transurethral, and transvaginal approaches. Conservative treatment was associated with a 100% risk of persistence or recurrence of urethral perforation, while the failure rates for endoscopic, transurethral, and transvaginal approaches were 33%, 7.5%, and 7%, respectively. Most patients suffered from stress urinary incontinence after reconstructive management. The most common symptoms at the time of presentation were overactive bladder and pain. The mean time between the onset of symptoms and diagnosis was 10 months. About half of the urethral mesh perforations were diagnosed within the first years after the initial sling insertion. CONCLUSIONS Multiple management options for sling penetration of the urethra have been described in the literature. Transvaginal sling resection with consecutive tissue interposition seems to carry the lowest risk of erosion recurrence; however, all treatment options are associated with a high relapse rate for stress urinary incontinence.
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Affiliation(s)
- Amélie Bazinet
- Department of Urology, Université de Montréal, Maisonneuve-Rosemont Hospital, Montreal, QC, Canada
- Service d’Urologie, CHU de Grenoble, La Tronche, France
| | - Sylvia Weis
- Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
- Assistance Publique - Hôpitaux de Paris, Paris, France
| | | | - Bernard Boillot
- Service d’Urologie, CHU de Grenoble, La Tronche, France
- Service d’Urologie, Hôpital Foch, Suresnes, France
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Puzio CL, Edelstein RA. Urethral synthetic mesh erosion with formation of a large bladder and urethral stone: A case report. Case Rep Womens Health 2023; 38:e00502. [PMID: 37082335 PMCID: PMC10111930 DOI: 10.1016/j.crwh.2023.e00502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 03/26/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023] Open
Abstract
Synthetic urethral support mesh has been used for many years for the treatment of urinary stress incontinence. Late complications such as pain, mesh erosion, and recurrent urinary tract infection have been well described. A 57-year-old patient presented with a primary complaint of worsening lower urinary tract obstruction. She had undergone placement of a pubovaginal tension-free vaginal tape for the treatment of urinary stress incontinence 13 years earlier. A workup revealed a large stone arising from a section of mesh that had eroded into the proximal urethra. The stone extended from the erosion site into the bladder, creating a high-grade obstruction at the bladder neck. It is quite uncommon to see such a large stone in this setting. The long interval between the original surgery and the subsequent presentation of this complication is also unusual. A high index of suspicion is needed to evaluate late urologic complications related to implanted synthetic mesh.
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Maetzold E, Takacs EB. Urethral Pathology in Women. Curr Urol Rep 2022; 23:225-234. [DOI: 10.1007/s11934-022-01109-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2022] [Indexed: 11/03/2022]
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10
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Management of mesh complications after prolapse and incontinence surgery. Arch Gynecol Obstet 2022; 306:1837-1844. [PMID: 35994109 DOI: 10.1007/s00404-022-06759-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Allagany F, Dekalo S, Welk B. Endoscopic management of intraurethral mesh extrusion with the holmium:YAG laser is an acceptable treatment option in selected patients. Neurourol Urodyn 2022; 41:1511-1516. [PMID: 35731014 DOI: 10.1002/nau.24999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 06/05/2022] [Accepted: 06/13/2022] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Extrusion of transvaginal mesh into the urethra is a rare but potentially serious complication. Our objective is to evaluate the efficacy and long-term outcomes of women who underwent an endoscopic laser procedure to treat intraurethral mesh. MATERIALS AND METHODS A retrospective chart review identified women who underwent an endoscopic Holmium:YAG laser procedure to treat intraurethral mesh between September 2011-October 2021. Information about the procedure, symptoms, and level of incontinence was gathered from the medical records. Primary outcomes were the need for further procedures, and the Urinary Distress Index-6 score at last follow-up. RESULTS We identified a total of 29 women; mesh sling procedure included tension-free vaginal sling (19), transobturator sling (6), or other transvaginal mesh sling (4). Presentation of intraurethral mesh was a median of 6 (interquartile range [IQR]: 1-7) years after placement. After the endoscopic procedure, 18/29 (62%) women had no visible urinary mesh and complete resolution of their presenting symptoms. Retreatment was necessary in 3/29 women, and 6/29 (21%) reported new or worsening stress incontinence. The UDI-6 was completed by all patients at a median of 3.7 (IQR: 2.0-5.8) years after their endoscopic procedure. The median score was 22 (IQR: 11-44), and 18/29 (62%) women had scores in the asymptomatic range. UDI-6 scores were similar for the six women who had further mesh procedures and the ones who did not. CONCLUSIONS Endoscopic laser treatment of an eroded transvaginal mesh sling is an acceptable treatment with minimal morbidity and satisfactory UDI-6 scores after a median follow-up of 3.7 years.
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Affiliation(s)
- Feras Allagany
- Department of Obstetrics and Gynecology, Western University, London, Ontario, Canada
| | - Snir Dekalo
- Department of Surgery and Epidemiology and Biostatistics (Urologist), Western University, London, Ontario, Canada
| | - Blayne Welk
- Department of Surgery and Epidemiology and Biostatistics (Urologist), Western University, London, Ontario, Canada
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Hermieu N, Ouzaid I, Aoun R, Xylinas E, Hermieu JF, Schoentgen N. Urethral exposure of mid-urethral sling: diagnosis, management and functional outcomes. Urology 2022; 164:100-105. [PMID: 35065985 DOI: 10.1016/j.urology.2022.01.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 01/10/2022] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To identify symptoms leading to urethral mesh exposure diagnosis, describe the surgical management and evaluate post-operative functional and urodynamic outcomes. METHODS Retrospective observational monocentric study of 15 patients treated by mid-urethral sling removal for urethral exposure, between December 2005 and February 2021, in a pelviperineology centre. RESULTS Fifteen patients were included. The mean time to diagnosis of urethral exposure was 43 months. This diagnosis delay was caused by a non-specific symptomatology. Surgical management consisted of partial removal of the eroded mid-urethral sling fragment by vaginal approach in all cases, with low peri-operative morbidity. At three months follow-up, 87% of the patients had stress urinary incontinence versus 54% at two years. 13 patients had a urodynamic assessment after their mid-urethral sling removal, they all had sphincter insufficiency with a urethral closure pressure lower than 30 cm H2O. Nine patients underwent a second urinary incontinence management procedure, leading to 77% of complete remission and 23% of partial improvement. CONCLUSION Clinical presentation of urethral erosion after mid-urethral sling is heterogeneous. Surgical management is complex; after a good preoperative evaluation, a two-step management strategy including minimally invasive mid-urethral sling removal and treatment of recurrent urinary incontinence leads to good results with 77% of patients cured. Sphincter insufficiency is one of the mechanisms that may explain the high rate of stress urinary incontinence after urethral mesh erosion surgery.
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Affiliation(s)
- Nicolas Hermieu
- Department of Urology, Bichat Claude Bernard Hospital, Paris, France University of Paris, Paris, France,.
| | - Idir Ouzaid
- Department of Urology, Bichat Claude Bernard Hospital, Paris, France University of Paris, Paris, France,.
| | - Rana Aoun
- Department of Urology, Bichat Claude Bernard Hospital, Paris, France,.
| | - Evanguelos Xylinas
- Department of Urology, Bichat Claude Bernard Hospital, Paris, France University of Paris, Paris, France,.
| | - Jean-François Hermieu
- Department of Urology, Bichat Claude Bernard Hospital, Paris, France University of Paris, Paris, France,.
| | - Nadja Schoentgen
- Department of Urology, Bichat Claude Bernard Hospital, Paris, France,.
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O'Kane M, Araklitis G, Rantell A, Robinson D, Cardozo L. Conservative management of intravesical erosion of a synthetic mid-urethral sling for the treatment of stress urinary incontinence, based on patient preference: A case report. Case Rep Womens Health 2022; 33:e00383. [PMID: 35127457 PMCID: PMC8810362 DOI: 10.1016/j.crwh.2022.e00383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/08/2022] [Accepted: 01/10/2022] [Indexed: 12/05/2022] Open
Abstract
Background Intravesical mesh erosion is an uncommon late complication of placement of a synthetic mid-urethral sling (MUS) for the treatment of stress urinary incontinence, and only a few cases have been reported. Optimal management remains controversial, though there is a tendency toward surgical removal through a variety of routes. However, surgical removal comes with its own risks and is not necessarily associated with an improvement in symptoms. We, herein present the first case of a conservatively managed intravesical mesh erosion following MUS placement. Case Nine years after insertion of a tension-free vaginal tape (TVT), a patient presented with persistent lower abdominal pain and dysuria. Flexible cystoscopy demonstrated an erosion of the tape through the bladder wall. The patient declined surgical intervention at the time. Therefore, she was commenced on regular methenamine hippurate and vaginal oestrogen, and kept under surveillance with regular cystoscopies. Her symptoms responded to this treatment and 6 years later remained well controlled on this regime. Conclusion This case demonstrates that conservative management may be a safe and appropriate option for patients who decline surgical excision of mesh erosion. Till recently, tension-free vaginal tape (TVT), was the most popular surgical treatment of stress urinary incontinence (SUI). Intravesical mesh erosion, though uncommon, can occur with delayed presentation. Surgical excision of mesh may not cure the presenting complaint and may cause de novo/recurrent lower urinary tract symptoms. Patients may prefer expectant/conservative management rather than surgical intervention to control symptoms caused by mesh erosion. Conservative management may be a safe alternative to surgery in patients who are willing to remain under long-term surveillance.
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Cour F, Munier P, Kaulanjan K, Vidart A, Bosset PO, Neuzillet Y. Small intestinal submucosa xenograft to manage lower urinary tract prostheses perforation: a new path? Int Urogynecol J 2021; 33:627-635. [PMID: 33787953 DOI: 10.1007/s00192-021-04771-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 03/16/2021] [Indexed: 12/01/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Tapes for stress urinary incontinence (SUI) and meshes for pelvic organ prolapse can result in postoperative complications, such as urethral (UP) or bladder (BP) perforations. Martius fat pad (MFP) is an historic procedure, widely used to treat lower urinary tract (LUT) fistulae. We report our experience with the insertion of the biological small intestinal submucosa (SIS) xenograft as an alternative to MFP in these prosthetic complications. METHODS We conducted a retrospective, monocentric study which included all patients who underwent SIS insertion during surgical removal of tape/vaginal mesh for UP or BP from 2011 to 2019. Preoperative assessment was based on history, symptoms, physical examination and urethrocystoscopy. Primary outcome was successful repair defined as absence of any LUT defect. Secondary outcomes were complications, LUT symptoms, pain and additional SUI surgical procedures. RESULTS Thirty-eight patients were included. Twenty-six had a UP and eight a BP. In four cases, perforation involved both the bladder neck and urethra. All LUT defects were cured. Six postoperative complications were reported (five of grade ≤ 2 and one of grade 3b according to the Clavien-Dindo classification). At the mean follow-up of 37.2 (range 6-98) months, 14 patients (36.8%) presenting a postoperative SUI underwent a SUI surgical procedure and 1 patient had a laparoscopic sacrocolpopexy for cystocele recurrence. CONCLUSION Absorbable SIS xenograft is an effective and safe graft for the management of lower urinary tract tape and mesh perforations. The cost has to be balanced with the good results, short operative time and no fat pad complications as in MFP.
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Affiliation(s)
- Florence Cour
- Department of Urology, Foch Hospital, 40 Rue Worth, 92150, Suresnes, France.
| | - Pierre Munier
- Department of Urology, Foch Hospital, 40 Rue Worth, 92150, Suresnes, France
| | - Kevin Kaulanjan
- Department of Urology, Foch Hospital, 40 Rue Worth, 92150, Suresnes, France
| | - Adrien Vidart
- Department of Urology, Foch Hospital, 40 Rue Worth, 92150, Suresnes, France
| | | | - Yann Neuzillet
- Department of Urology, Foch Hospital, 40 Rue Worth, 92150, Suresnes, France.,University of Versailles-Saint-Quentin-en-Yvelines, Versailles, France
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Morton S, Wilczek Y, Harding C. Complications of synthetic mesh inserted for stress urinary incontinence. BJU Int 2020; 127:4-11. [PMID: 32981191 DOI: 10.1111/bju.15260] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/24/2020] [Accepted: 09/24/2020] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To provide an update on the literature regarding the management of complications secondary to synthetic mesh placed to treat stress urinary incontinence (SUI). METHODS We performed a systematic review of the literature using a multi-database structured search within OVID, the Medical Literature Analysis and Retrieval System Online (MEDLINE), the Excerpta Medica dataBASE (EMBASE) and Cochrane library databases; using the keywords: urology, incontinence, mesh and surgery. RESULTS Several million synthetic polypropylene meshes have been inserted into women worldwide to manage SUI. Unfortunately, a significant number of women have now reported life-changing complications. We found a paucity of studies, heterogeneity of cohorts, poor long-term follow-up, and lack of evidence on the effective management of mesh-related complications. CONCLUSIONS The contemporary evidence is low-level and often contradictory, which prevents robust recommendations regarding treatment. A prospective registry will be required to generate meaningful outcome data and help in the complex management of patients who have mesh-related complications.
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Affiliation(s)
- Simon Morton
- Department of Urology, Freeman Hospital, Newcastle upon Tyne, UK
| | - Yasmine Wilczek
- Department of Urology, Freeman Hospital, Newcastle upon Tyne, UK
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Abstract
PURPOSE OF REVIEW After the Food and Drug Administration Public Health Notification in 2011 regarding transvaginal mesh, there has been a decline in the use of mid-urethral slings (MUS). However, they are an effective treatment option for stress urinary incontinence (SUI) with minimal complications. The management of recurrent SUI after sling continues to be debated. RECENT FINDINGS Long-term follow-up after primary MUS confirms its efficacy and safety. There remains no level 1 evidence for the best next step after a failed MUS. Preferred treatment strategies include placing a repeat MUS with more recent evidence demonstrating no difference in cure rates between transobturator tape and retropubic approach. Pubovaginal slings (PVS) and urethral bulking agents are also acceptable treatment options. A newer bulking agent, polyacrylamide hydrogel, demonstrated excellent short-term success rates in patients after a failed sling. SUMMARY MUS is an effective treatment option for SUI. Patients who develop recurrent urinary incontinence are a heterogeneous population who must be evaluated for detrusor overactivity, misplaced sling, unrecognized ISD. Patients with ISD are more likely to benefit by a PVS. Other patients with demonstrated recurrent SUI will likely do well with a repeat MUS.
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Law J, Welk B. The risk of stress incontinence after urethral surgery in women. Can Urol Assoc J 2020; 15:E74-E75. [PMID: 32701442 DOI: 10.5489/cuaj.6583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Jeffrey Law
- Division of Urology, Department of Surgery, Western University, London ON, Canada
| | - Blayne Welk
- Division of Urology, Department of Surgery, Western University, London ON, Canada
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Siddharth A, Hussain MJ, Cartwright R, Jackson S, Price N. A novel technique for complete laparoscopic excision of a transobturator sling with lower urinary tract mesh erosion. Int Urogynecol J 2020; 31:839-841. [PMID: 32103312 DOI: 10.1007/s00192-020-04264-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 02/11/2020] [Indexed: 11/25/2022]
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.
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Affiliation(s)
- Aditi Siddharth
- John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU, UK.
| | - Mohammed J Hussain
- Milton Keynes Hospital NHS Foundation Trust, Standing Way, Eaglestone, Milton Keynes, MK6 5LD, UK
| | - Rufus Cartwright
- John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU, UK
| | - Simon Jackson
- John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU, UK
| | - Natalia Price
- John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU, UK
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