Intravesical Mesh Research Articles

Clinical Study of Combined Endoscopic And Percutaneous Management of a Late Complication Following Tension-free Vaginal Tape (TVT) Anchored Stone for Female Stress Urinary Incontinence

TVT is a simple and less-invasive variation of the suburethral sling with higher success rates1. It has beenrapidly gaining popularity worldwide but it has also lead to increasing number of patients presenting withassociated complications. Bladder erosion through the bladder wall occuring predominantly within the first2 years the placement of TVT is producing tension or in the close proximity of the bladder..Formation of acalculus in the urinary bladder secondary to an intravesical mesh erosion is relatively infrequent rare anddelayed complication.Owing to the scarcity of the data on mesh erosion there is no consensus regarding theideal approach to remove the mesh Combined endoscopic and percutaneous approach should be opted as thepreferred approach .Open surgery should be opted only if minimal invasive approach fails.

28: Management of intravesical mesh and incisional pain after midurethral sling placement

The objective of this video is to demonstrate the laparoscopic excision of an intravesical midurethral sling with concurrent removal of the sling arm through a suprapubic skin incision. This video describes the excision of both intravesical midurethral sling and incisional pain temporally related to the same surgical procedure. The patient described is a 48 year old who underwent Lynx retropubic midurethral sling placement at an outside facility. Review of her operative note revealed the fact that there was gross hematuria with bladder drainage after sling placement, however cystoscopy demonstrated no evidence of bladder injury. One week later, she developed a large hematoma and underwent evacuation, with an incision made through her left suprapubic incision. She presented to our practice 10 months later with urgency, frequency, recurrent urinary tract infections, and left sided incisional pain. Physical examination revealed significant tenderness and nodularity along her left suprapubic incision. Cystoscopy demonstrated a 2 cm intravesical portion of the midurethral sling penetrating the left dome of the bladder. The decision was made to proceed with laparoscopic removal of the intravesical mesh and complete removal of the left sided sling arm through a small suprapubic incision. Management of both intravesical midurethral sling and incisional pain is able to be accomplished using a laparoscopic approach with extraction through prior suprapubic incision.

Intravesical midurethral sling mesh erosion secondary to transvaginal mesh reconstructive surgery

Abstract Objective We sought to evaluate the feasibility and the outcomes of correcting the intravesical mesh erosion after secondary mesh augmented pelvic reconstructive surgery pervaginally. Methods We evaluated a case of mesh erosion following midurethral sling that occurred 4 years after secondary mesh surgery. Prior to second surgery, ultrasound and cystoscopy examination were performed to exclude mesh complication. Serial examinations during follow-up after the operation were uneventful until the patient presented 4 years after the second surgery with a history of dysuria and hematuria. Cystoscopy examination discovered intravesical mesh erosion 4 years after the secondary surgery. Removal of the midurethral sling mesh erosion and bladder repaired were done vaginally. Results The patient was still symptom free and continent 1 year following tape excision. Urodynamic evaluation 6 months post-tape excision was also normal. Conclusion Repeated vaginal reconstructive surgery may jeopardize a primary mesh or sling, and pose a high risk of mesh erosion, which may be delayed for several years. Removal of the mesh erosion and bladder repair are feasible pervaginally with good outcome.

Outcomes of transurethral resection (TUR) of intravesical mesh after suburethral slings in the treatment of urinary stress incontinence

ObjectiveThe objective of this study was to determine the efficacy as well as the complications associated with transurethral removal (TUR) of intravesical mesh, after suburethral sling, transobturator tape-TOT (Monarc™) or “minisling” (MiniArc®), in the treatment of female urinary stress incontinence (USI). Materials and methodsA retrospective and consecutive study on 9 women with bladder perforation after midurethral slings (3 Monarc™ and 6 MiniArc®) placement for urinary stress incontinence. To remove the mesh, transurethral resection with an electrode loop (TUR-E) was used. The technique included location and total removal of mesh up to healthy tissue with bipolar resectoscope. ResultsThe median age was 61 years (49–70 years). The median time between midurethral sling placement and onset of the symptoms was 13 months (1–79 months) and between sling placement and mesh removal it was 16 months (1–91 months). Five women (55.5%) developed bladder stones. Mean operating time was 29.4±10.4min and mean length of hospital stay was 2.6±0.5 days. The median follow-up after mesh removal was 38 months (range, 14–109 months). No complications were found. ConclusionsThe use of transurethral resection of intravesical mesh after suburethral slings is easy and the results obtained by our surgical team are excellent.

Robotic Resection of Intravesical Polypropylene Mesh following Tension-Free Tape Procedure

To present a case of intravesical TVT mesh remote from insertion and demonstrate one possible technique for resection of the retropubic mesh arms. Tension-free vaginal tape (TVT) is the mainstay of treatment for stress urinary incontinence, and though major complications are rare, most are associated with the blind passage of the TVT trocars through the retropubic space. This video reviews TVT complications and treatment options for intravesical polypropylene mesh. This introduction is followed by a case presentation of a 43 year old para 2 female who underwent laparoscopic robotic removal of TVT after two years after the initial procedure. There are several options for surgical treatment of intravesical mesh issues following TVT, including vaginal, laparoscopic (with or without robotic assistance), and open procedures which can either completely or partially remove the polypropylene mesh depending on the TVT issues in question (intravesical mesh, pelvic pain, dyspareunia, etc.). This video demonstrates our preferred method of laparoscopic robotic assisted removal of the retropubic TVT arms in cases of intravesical mesh remote from initial surgery.

Resultados de la resección transuretral (RTU) de malla intravesical tras tratamiento con cintillas suburetrales para la incontinencia urinaria de esfuerzo

ObjectiveThe objective of this study was to determine the efficacy as well as the complications associated with transurethral removal (TUR) of intravesical mesh after suburethral sling, transobturator tape-TOT (Monarc™) or “minisling” (MiniArc®), in the treatment of female urinary stress incontinence (USI). Material and methodsretrospective and consecutive study on 9 women with bladder perforation after midurethral slings (3 Monarc™ and 6 MiniArc®) placement for urinary stress incontinence. To remove the mesh, transurethral resection with an electrode loop (TUR-E) was used. The technique included: location and total removal of mesh with bipolar resectoscope up to healthy tissue. ResultsThe median age was 61 years (49-70 years). The median time between midurethral sling placement and onset the sympltoms was 13 months (1-79 months). and between sling placement and mesh removal was 16 months (1-91 months). Five women (55.5%) developed bladder stones. Mean operating time was 29.4±10.4minutes and mean length of hospital stay was 2.6±0.5 days. The median follow-up after mesh removal was 38 months (range, 14 to 109 months). No complications were found. ConclusionsThe use of transurethral resection of intravesical mesh after suburethral slings is easy and the results obtained by our surgical team are excellent.

Sacral colpopexy: long-term mesh complications requiring reoperation(s).

Sacral colpopexy (SC) is a classic procedure used for the surgical treatment of pelvic organ prolapse. Although the procedure boasts excellent success rates, there are risks of complications and reoperation may be required. The purpose of this study was to evaluate the extent of complications following SC, requiring reoperation(s), and to describe the reoperations performed. A retrospective monocentric study of patients who were operated on following a mesh complication after SC was conducted, at Lille University Hospital, between January 2007 and January 2013. Information relating to medical and surgical history, SC surgical technique, type of complication, and reoperation techniques was gathered. Twenty-seven patients required surgery for complications after SC. Nineteen patients were treated for vaginal mesh exposures (VME), four for intravesical mesh (including one with VME), one for ano-rectal dyschezia, one for spondylodiscitis with a VME, one for mesh infection, and one for vaginal fistula communicating with a collection in the ischio-coccygeal muscle. The median time between the initial SC and the first reoperation was 3.9 ± 5.7 years. The median operating time was 40 ± 95 min, and the length of hospital stay was 3.0 ± 3.0 days. Ten patients needed several interventions. This case series provides a description of surgical interventions for complications related to sacral colpopexy. These complications may be serious and occur years after the initial surgery.

A technique of laparoscopic mesh excision from the bladder after sacrocolpopexy

Several series have demonstrated the feasibility, safety, and efficacy of laparoscopic sacrocolpopexy. Nonetheless, complications such as mesh erosion into the bladder can occur years after primary surgery, with accidental cystotomy during the primary operation appearing to be a risk factor for later mesh erosion. Over the last 10 years, we have treated 7 patients with mesh erosion into the bladder after laparoscopic sacrocolpopexy using a technique of transvesical laparoscopic partial excision of the eroded mesh. None of these 7 patients developed recurrent erosions, fistulas, or recurrent prolapse. The video demonstrates laparoscopic excision of intravesical mesh in a patient 5 years after laparoscopic sacrocolpopexy. Key steps are opening the bladder to grasp and dissect the eroded mesh; partial resection of the mesh with formation of a bladder flap; and closure of the bladder. Laparoscopy appears to be a useful tool for the treatment of this problem. Because many urogynecology units around the world have now begun to perform laparoscopic sacrocolpopexy, urogynecologists should be aware of these complications and how to treat them. The video is intended to help and encourage centers performing laparoscopic transvesical excision of mesh eroded into the bladder after sacrocolpopexy.

Suprapubic mini-laparoscopy-assisted transurethral thulium laser excision of intravesical mesh after anti-incontinence sling procedures

ObjectivesWe present our innovative technique of excising intravesically exposed mesh resulting from anti-incontinence sling procedures using transurethral thulium laser assisted by a suprapubic transvesical mini-laparoscopic grasper. MethodsTwo patients agreed to anti-incontinence sling surgery for stress urinary incontinence several years ago prior to presentation. Because of symptom recurrence, they underwent repeat anti-incontinence sling surgery. One patient developed dysuria and mild lower abdominal pain gradually 1 month after the operation. Cystoscopy was performed and revealed exposed mesh at the left anterolateral wall, which might have resulted from missed intraoperative bladder perforation. The other patient presented with dysuria 2 years following the second sling procedure. Cystoscopy demonstrated a calcified mass attached to the right lateral wall. Bladder erosion by a previously implanted mesh was thought to be the cause. Intravesical mesh was removed transurethrally with thulium laser assisted by a suprapubic transvesical mini-laparoscopic grasper for the former patient. Vesicolithotripsy was performed for the latter patient first and the intravesical mesh was removed in the same manner as in the former patient. ResultsThe intravesical mesh was removed smoothly with thulium laser with the assistance of a suprapubic mini-laparoscopic grasper. As the procedure was minimally invasive, both patients recovered well after removal of the intravesical mesh. The irritative voiding symptoms also subsided following removal of the mesh. ConclusionRemoval of eroded or misplaced intravesical mesh after anti-incontinence sling procedures can be accomplished by transurethral laser excision with the assistance of suprapubic transvesical mini-laparoscopic instruments. The procedure is safe, effective, and minimally invasive, with a fast recovery.

Endoscopic holmium laser management of tension-free vaginal tape eroded into the bladder

Tension-free vaginal tape (TVT) procedure is not free from intra- and postoperative complications. Diagnosis of mesh erosion is often underestimated by clinicians due to its unspecific symptoms. Urinary symptoms not responding to medical therapy should be investigated by cystoscopy to exclude mesh erosion. We report our experience with holmium laser for the endoscopic management of mesh erosion in three patients. We describe three cases of mesh erosion after TVT placement treated with laser excision of the eroded tape into the bladder. In one case, a 4 × 3 cm stone adhering to the mesh was present. The procedures were performed under spinal anesthesia. The polypropylene eroded mesh was mobilized with forceps to better expose the intramural portion of the sling, and it was disintegrated with holmium laser as close to the bladder mucosa as possible. No complications were recorded. The patients were discharged after 24 h. In only one case, we had recurrent mesh exposure requiring a second procedure. After a mean follow-up of 15.3 months (range 12-20), the patients are asymptomatic with no evidence of tape erosion. Intravesical mesh erosion can complicate sling procedure. Endoscopic holmium laser management is a useful treatment for mesh removal and stone lithotripsy. Repeated treatments are possible for the low morbidity and minimal invasiveness. A regular follow-up is necessary.

Laparoscopic Management of Intravesical Mesh Erosion with Bladder Stone

A 57 year old G4P2 woman presents with recurrent UTIs and gross hematuria. Her surgical history was significant for a transvaginal mesh procedure followed by a laparoscopic sacrocolpopexy for recurrent prolapse. Office cystoscopy revealed a bladder stone with underlying mesh fibers.

Novel endoscopic management of a late complication following TVT insertion for stress urinary incontinence

Patient: Female, 57 FinalDiagnosis: Bladder erosionSymptoms: Haematuria • irritative bladder symptoms • recurrent UTIMedication: —Clinical Procedure: Endoscopic tape resectionSpecialty: UrologyObjective:Unusual or unexpected effect of treatmentBackground:Since 1995 over 1 million tension free vaginal slings have been utilized to treat stress incontinence. The 10 year success rates range from 84–93%. Complication rates are low by comparision. Bladder perforation occurring during the time of surgery and is managed effectively if diagnosed and treated intraoperatively. However bladder erosion occuring post-operatively predominantly occur within the first 2 years. The risk of erosion increases with body mass index and previous vaginal surgery.Case Report:We report the case of a bladder erosion occurring 5 years following the original surgery. The symptoms included recurrent urinary tract infections, frequency and haematuria. A novel technique was employed using the transurethral approach to initially disintegrate the calculus and then using an endoshears to excise the mesh below the level of the epithelium. Continence was maintained postoperatively.Conclusions:This approach provides a safe alternative to both the transvaginal and transabdominal approach to excising intravesical mesh.

Antegrade Endoscopic Removal of Retained Urethral Sling Mesh in the Bladder

The midurethral sling has emerged as an effective, minimally invasive treatment for patients with stress urinary incontinence. Bladder penetration is a known complication that, if unrecognized, may result in retained intravesical mesh. This rare complication can cause patient discomfort as well as become a nidus for infection and bladder calculi. Because of the technique of sling passage, the site of retained sling material is often along the anterior bladder wall, making evaluation and treatment via traditional retrograde cystoscopy prohibitively difficult. We describe a novel and minimally invasive method to remove the sling material using antegrade access into the bladder in conjunction with holmium laser vaporization. In our series of six patients in whom retrograde cystoscopic treatment had failed, all were successfully treated with antegrade cystoscopy and reported improved urinary symptoms. This new technique provides a simple, minimally invasive, and effective method for removal of exposed sling mesh.

1346 OUTCOMES OF TRANSURETHRAL REMOVAL OF INTRAVESICAL OR INTRAURETHRAL MESH FOLLOWING MIDURETHRAL SLING SURGERY

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Incontinence - Evaluation & Therapy III1 Apr 20121346 OUTCOMES OF TRANSURETHRAL REMOVAL OF INTRAVESICAL OR INTRAURETHRAL MESH FOLLOWING MIDURETHRAL SLING SURGERY Dong-Soo Ryu, Young-Suk Lee, Tae-Hee Oh, and Kyung-Won Kwak Dong-Soo RyuDong-Soo Ryu Changwon, Korea, Republic of More articles by this author , Young-Suk LeeYoung-Suk Lee Changwon, Korea, Republic of More articles by this author , Tae-Hee OhTae-Hee Oh Changwon, Korea, Republic of More articles by this author , and Kyung-Won KwakKyung-Won Kwak Changwon, Korea, Republic of More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1729AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Intravesical and intraurethral mesh following midurethral sling procedure to treat female stress urinary incontinence are not common, but troublesome complications. We assessed our experience with transurethral removal of intravesical or intraurethral mesh with an electrode loop or a Holmium laser. METHODS The 23 consecutive women who underwent transurethral removal of mesh with an electrode loop (TUR-E) in 16 and a Holmium laser (TUR-H) in 7 at our institution between January 2002 and December 2010 were included. Of the 23 patients, 20 (87%) were intravesical mesh and remaining 3 (13%) were intraurethral mesh. When the stone fomation from the mesh was found, lithotrisy was performed with a lithoclast or Holmium laser. RESULTS At the time of surgery, the median age of patient was 51 (range, 40-67) years, and 17 women (74%) had calculi. The median period between the midurethral sling and mesh removal was 31.3 (2.2-247.6) months, and the median follow-up period after mesh removal was 2.1 (0.3-35.9) months. Twenty-six percent of women (6/23) had a mesh remnant; 6.2% (1/16) of women treated with TUR-E and 71.4% (5/7) of women treated with TUR-H. Of the five women treated with TUR-H, 3 underwent concomitant transvaginal removal. On the follow-up cystoscopic exam, a mesh remnant was observed in three women (one treated with TUR-E and two treated with TUR-H). Vesico-vaginal fistula were found in two women during and after TUR-E. Stress urinary incontinence recurred in one woman. CONCLUSIONS Transurethral resection of mesh after the midurethral sling procedure has good functional outcomes, low surgical mobidity, and low risk of recurrence of stress incontinence. Transurethral resection with a electode loop has better success rate than Holmium laser because this had narrow range of motion of the instrument. However, TUR-E might has a risk of bladder perforation while TUR-H has minimal risk of tissue damage. Therefore, the choice of the best treatment modality should be selected according to the location of mesh and the availability of instruments. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e546 Peer Review Report Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Dong-Soo Ryu Changwon, Korea, Republic of More articles by this author Young-Suk Lee Changwon, Korea, Republic of More articles by this author Tae-Hee Oh Changwon, Korea, Republic of More articles by this author Kyung-Won Kwak Changwon, Korea, Republic of More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Cystoscopic removal of intravesical synthetic mesh extrusion with the aid of Endoloop sutures and endoscopic scissors

Synthetic mesh is commonly used in urogynecologic surgical procedures for correction of stress urinary incontinence and pelvic organ prolapse. Bladder mesh extrusion is a recognized complication and frequently requires extensive mesh resection. We present a case of intravesical polypropylene mesh extrusion following a combined mesh kit and midurethral sling placement. A novel transurethral approach, employing Endoloop sutures with endoscopic scissors, was used to resect the protruding mesh located in close proximity to a ureteral orifice. Medline was searched for other minimally invasive treatment strategies for bladder mesh extrusion. Various techniques for minimally invasive resection of extruded intravesical mesh have been described in the literature. Our strictly transurethral approach avoids the use of an energy source and eliminates the need for open or extensive surgery. Advantages of this new transurethral operative technique include decreased risk of injury associated with the use of an energy source within the bladder and avoidance of open surgical complications.

Percutaneously Assisted Cystoscopic Removal of Intravesical Mesh Erosion

This describes a novel approach to cystoscopic removal of a mesh erosion occurring 3 months after anterior vaginal repair with mesh augmentation.

Transurethral holmium laser intravesical tape excision following TVT procedure: results from seven patients in a 12-month follow-up

The aim of this study is to evaluate the efficacy and the safety of the holmium:YAG laser for intravesical mesh excision in female patients with urinary bladder erosion complicated tension-free vaginal tape (TVT) procedure. Between June 2, 2008 and December 31, 2009, seven patients who underwent laser excision of an intravesically protruding tape were followed up every 3 months for a total period of 1 year by disease-specific questionnaires, physical examination, cough stress test, urine analysis, urine bacterial culture, ultrasound and uroflowmetry. Filling cystometry was offered preoperatively and at the 3rd month, while cystoscopy was offered preoperatively and at the 1st month. The presenting symptoms were dysuria, urgency, hematuria, and recurrent lower urinary tract infections. Holmium laser was used for ablation and removal of the tape. The postoperative period was uneventful. There was a substantial improvement in the urgency status, in the maximum flow rate (Q (max)) from 11.29 ml/s to 19.43 ml/s, in the voided volume (VV) from 185 ml to 251.43 ml and in the maximum cystometric capacity (C) from 237.86 ml to 310.64 ml pre- and postoperative, respectively. Holmium laser ablation represents a simple, safe and efficacious procedure to manage intravesical mesh complications following TVT procedure.

Laparoscopic removal of intravesical mesh following pelvic organ prolapse mesh surgery

With the increasing popularity of mesh in prolapse surgery, complications such as intravesical mesh will arise more frequently. In three cases intravesical mesh was identified in the trigone of the bladder following laparoscopic mesh hysteropexy, open sacral colpopexy, and transvaginal mesh repair and presented 9 months to 7 years later with a variety of symptoms including recurrent urinary tract infections, suprapubic pain, and constant urinary leakage. Each underwent uncomplicated laparoscopic transvesical removal of intravesical mesh. Intravesical mesh can present years following index prolapse surgery and can develop despite the bladder integrity being documented as being intact at the initial surgery. The laparoscopic approach to the removal of intravesical mesh is feasible, minimally invasive, and a precise approach to this challenging complication.

Outcomes of Transurethral Removal of Intravesical or Intraurethral Mesh Following Midurethral Sling Surgery

PurposeTo present outcomes of transurethral removal (TUR) of intravesical or intraurethral mesh after midurethral slings.Materials and MethodsThis was a retrospective chart review of 23 consecutive women: 20 with intravesical mesh and 3 with intraurethral mesh.ResultsTo remove the mesh, transurethral resection with an electrode loop (TUR-E) was used in 16 women and transurethral resection with a holmium laser (TUR-H) was used in 7. The median follow-up was 2.1 months. Twenty-six percent of the women (6/23) had a mesh remnant: 6.2% (1/16) of the women treated with TUR-E and 71.4% (5/7) of the women treated with TUR-H. Of the 5 women treated with TUR-H, 3 underwent concomitant transvaginal removal. On the follow-up cystoscopic exam, a mesh remnant was observed in 3 women (1 treated with TUR-E and 2 treated with TUR-H). Vesico-vaginal fistulas were found in 2 women during and after TUR-E, respectively. Stress urinary incontinence recurred in 1 woman.ConclusionsTUR-E has a high success rate but carries a risk of bladder perforation. Complete resection using TUR-H depends on the location of the mesh and the range of motion of the instrument.

Repeated Endoscopic Excision of an Eroding Calcified Mesh Sling—Continued Follow-Up Is Required

The tension-free vaginal tape (TVT) procedure is the most popular worldwide for treating stress urinary incontinence. Intravesical mesh erosion related to the use of the TVT sling is rare. We report a rare case of mesh erosion over the bladder dome, with stone formation developing 11 years after TVT surgery. The diagnosis was made by cystoscopic examination after a 5-month history of lower urinary tract symptoms. Cystoscopic cystolithotomy was performed. No obvious mesh material was seen except for a small filament that was excised cystoscopically. Repeat cystoscopic follow-up was performed a year later. A recurrent stone formation resulted from a nonvisible mesh filament. Repeat cystoscopic cystolithotomy was performed, and the patient refused further surgical intervention. In women with a history of undergoing the TVT procedure and who have persistent lower urinary tract symptoms, a cystoscopic examination is mandatory to avoid delay in diagnosis and underreporting of sling-related complications. Despite satisfactory cystoscopic management, long-term regular follow-up is still required.