Suprapubic-Assisted Transurethral Excision of Eroded Transvaginal Cerclage Suture

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<h3>Study Objective</h3> To demonstrate our minimally invasive technique for excision of eroded transvaginal cervical cerclage suture through the bladder mucosa using a suprapubic-assisted transurethral approach. <h3>Design</h3> A narrated, stepwise video demonstration of our suprapubic-assisted transurethral technique. <h3>Setting</h3> Transvaginal cervical cerclage is a common treatment for cervical insufficiency. Complications such as erosion are rare as the duration of treatment is typically several months, with cerclage placement in the second trimester and complete removal prior to the onset of labor. Retained suture can lead to erosion through the vaginal epithelium and into other organs as seen in our case. Our technique offers a minimally invasive approach for excision of eroded transvaginal cervical cerclage suture through the bladder mucosa. <h3>Patients or Participants</h3> A single patient was included as part of this case. <h3>Interventions</h3> Suprapubic-assisted transurethral approach for excision of eroded transvaginal cervical cerclage suture through the bladder mucosa with key strategies for successful outcome. 1. A Carter-Thomason device can be used as a minimally invasive approach for suprapubic assistance in lieu of suprapubic trocar or suprapubic incision. 2. Rigid biopsy forceps can be used for improved traction at the time of eroded suture removal from the bladder mucosa. 3. For efficient excision, utilize countertraction on the suture with both suprapubic assistance and the biopsy forceps. 4. A Methylene Blue test should be performed to evaluate for a vesicovaginal fistula after excision of suture. <h3>Measurements and Main Results</h3> N/A. <h3>Conclusion</h3> A suprapubic-assisted transurethral approach can be used as a minimally invasive technique for excision of eroded transvaginal cervical cerclage suture through the bladder mucosa.