8: Use of suprapubic carter-thomason needle to assist in cystoscopic excision of intravesical foreign object

Abstract

We present a video of a minimally-invasive technique using the Carter-Thomason Needle Suture Passer for suprapubic assistance in the cystoscopic removal of the intravesical eroded suture. Suture injury to the bladder occurs in 0.6% of cases of retropubic bladder neck suspension procedures (1). These injuries can occur from inadvertent placement of the sutures through the bladder at the time of surgery or postoperative erosion or migration of the sutures into the bladder, and can lead to chronic inflammatory reaction in the wall of the bladder and stone formation. Common symptoms are of urinary frequency, urgency, urinary tract infection, voiding difficulty and pelvic pain. Intraoperative cystoscopy detects some, but not all, suture bladder injuries. It is therefore important to exclude intravesical foreign body in patients with lower urinary tract symptoms and a history of bladder neck suspension. We describe a case of a 63 year old woman with symptoms of recurrent urinary tract infections, urinary frequency, urgency, hesitancy, dysuria, microscopic hematuria and pelvic pain. She underwent a ‘bladder suspension’ 23 years prior for stress urinary incontinence, which she reported as being uncomplicated. Pelvic ultrasound demonstrated a 2cm bladder calculus. Office cystoscopy revealed a 3cm stone-encrusted suture erosion of the bladder. The use of a Carter-Thomason Needle Suture Passer for suprapubic assistance in the cystoscopic removal of intravesical suture is a minimally invasive surgical technique that can be applied to removal of other foreign objects, such as mesh. Compared to suprapubic trocars, prolonged catheterization and follow-up cystogram are not necessary.