You have accessJournal of UrologyFemale Voiding Dysfunction1 Apr 2016V2-01 TRANSVAGINAL SLING EXCISION: TIPS AND TRICKS Marisa Clifton and Howard Goldman Marisa CliftonMarisa Clifton More articles by this author and Howard GoldmanHoward Goldman More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2655AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Synthetic midurethral sling placement is the most common procedure performed for women with symptomatic stress urinary incontinence. Postoperative complications are well documented in the literature. The estimated rate of sling revision for urethral obstruction is approximately 2.3% and for mesh extrusion is 1.8%. However, this may be an underestimate of the true incidence. Herein, we present three separate cases of mesh excision and provide tips to improve surgical outcomes in these patients METHODS Three separate cases of mesh excision were recorded. Techniques utilized in sling excision were discussed in this video RESULTS Our first patient underwent transobturator sling in 2010 for symptomatic stress incontinence. Postoperatively, she developed voiding dysfunction and was evaluated for urinary hesitancy and weak stream. Her office cystoscopy was negative for mesh perforation and urodynamic study showed evidence of outlet obstruction. She elected to proceed with excision of a portion of the sling. Our second case is of a patient who underwent a sling for mixed urinary incontinence. Postoperatively, her urgency incontinence worsened significantly and she complained of significant dyspareunia. Her physical examination demonstrated pain where her sling was palpable at the midurethra. Cystoscopy was negative for mesh perforation, however, urodynamics showed evidence of bladder outlet obstruction. Our third patient underwent sling placement for stress incontinence in 2006. Approximately 2 months before presentation, her husband felt mesh during sexual intercourse. During physical examination, mesh was palpable at the right sulcus. The patient wished to have this portion of the sling removed. CONCLUSIONS In summary, plan incisions based on where mesh can be identified. If the location of the obstructing mesh is not apparent, use a cystoscope sheath or dilator to help with identification. If it is difficult to identify mesh during the dissection, a knife may help identify mesh from surrounding tissues. When performing sling excision for extrusion, ensure an adequate length of mesh is removed to prevent recurrence. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e180 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Marisa Clifton More articles by this author Howard Goldman More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...