51 Urethral mesh exposure of transobturator tape: Cystolithopaxy of urethral calculus and transurethral mesh excision

Abstract

The objective of this video is to demonstrate a dual modality technique for the removal of transurethral mesh exposure with an overlying obstructive urethral calculus using a transurethral Holmium laser and a transurethral and transvaginal approach to mesh dissection. A 55-year-old patient presented to our Female Pelvic Medicine and Reconstructive Surgery (FPMRS) clinic complaining of worsening mixed urinary incontinence, recurrent urinary tract infection and pelvic pain over the past four months. She had a history of trans obturator mid-urethral sling placed at an outside hospital in 2004. Office cystourethroscopy demonstrated an approximately 1 cm urethral calculus overlying a transurethral mesh exposure extending across the anterior urethral wall. A two-step surgical plan was made. The first procedure included cystolithopaxy of the urethral calculus. The second surgery included a transurethral and transvaginal resection of the trans obturator sling and exposed urethral mesh, as well as placement of an autologous rectus fascial sling for the patient’s ongoing stress urinary incontinence. Both surgeries are presented in this video. Mesh exposure is a rare complication of surgery for stress incontinence with mid-urethral sling; however, it is important that FPMRS providers are equipped with the surgical techniques for safe and effective removal. This video serves to educate the gynecologic community on one approach to successful surgical removal of a complicated urethral mesh exposure.