Hysteroscopy-guided transurethral resection for urethral exposure of mid-urethral slings

Abstract

Introduction and hypothesis.The mid-urethral sling (MUS) is a safe and effective treatment for women with stress urinary incontinence (SUI), but there is a long-term risk of exposure into the urethra. Although momentum has shifted from open vaginal repair to endoscopic approaches, research evidence is limited. Therefore, we present our experience with hysteroscopy and endoscopic scissors for the management of this complication. Methods:This case series describes patients who underwent surgery to treat urethral MUS exposure. All surgical procedures were performed under local or general anesthesia, using a hysteroscope to locate and visualize the MUS, endoscopic scissors to release visible exposure, and forceps to remove any material. Patients were routinely asked about symptom relief at 6 weeks. Results:Of the seven patients who underwent the hysteroscopic procedure, six needed a second session because mucosal bleeding or bulging caused poor visualization of the urethra. Six patients reported improvements after surgery. Of the four who reported recurrent SUI, two were successfully treated with a bulking agent. Although three of four patients who underwent cystoscopy during follow-up had residual MUS, all reported symptomatic improvement. Conclusion:The hysteroscopic approach appears to be an alternative for treating urethral MUS exposure. Patients should be informed that the procedure can be performed under local anesthesia, but that multiple sessions or procedures may be needed. Future research should consider whether symptom relief or the absence of MUS at cystoscopy defines success.