Sling Erosion Research Articles

Management of stress urinary incontinence using transobturator tape: a case series

Urinary incontinence is a health problem for women and the elderly, both physically and psychologically. To cure it, mid-urethral sling surgery is used. Moreover, the transobturator tape (TOT) appears to reduce the incidence of bladder injuries. This case series aims to assess the safety and efficacy of TOT at Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia. We present eleven female patients diagnosed with stress urinary incontinence (SUI) and complaints of involuntary leakage during sneezing, coughing, or laughing. All patients underwent a TOT operation, which included a coughing test, pad test, residual volume, and urinalysis to rule out the infection. Out of the eleven patients, eight showed the reported urinary leakage at the first follow-up, and three did not attend the follow-up. The pad test post-operative results from five patients were obtained: four patients revealed 0 g in their pad test, while one showed 3 g. No patient experienced sling erosion during control or follow-up management. The low erosion rate was due to the usage of type 1 polypropylene mashes (macropore, monofilament), and the procedure was done with the correct technique. The sling TOT procedure seems effective and has the potential to become the new gold standard in the management of true SUI with low morbidity.

Sonography as a Diagnostic Tool in Midurethral Sling Complications: A Narrative Review.

Despite the established safety and efficacy of midurethral slings (MUS), which are the current gold standard treatment for stress urinary incontinence (SUI), the potential for postoperative complications remains a significant concern for both healthcare professionals and patients. Meanwhile, sonography has emerged as a significant diagnostic tool in urogynecology, and one of the applications of this imaging modality may be the evaluation of complications arising from MUS procedures. This review, based on a comprehensive literature search, focuses on the use of pelvic floor ultrasound (US) in the context of MUS complications. It includes analyses of randomized controlled trials, prospective, and retrospective studies, covering preoperative and postoperative investigations, to assess complications such as persistent and recurrent SUI, urinary retention and obstructive voiding, de novo urgency/overactive bladder, vaginal exposure, sling erosion, pain, and hematoma. The review critically examines the existing literature, with a particular focus on recent publications. Despite the variability in findings, it appears that for each of the discussed complications, the application of pelvic floor US can significantly support the diagnostic and therapeutic process. The paper also identifies potential future directions for the development of US applications in diagnosing MUS complications.

Laser excision of urethral mesh erosion: a 10-year experience.

To review our 10-year experience with laser excision for urethral mesh erosion (UME) of mid-urethral slings (MUS). Following Institutional Review Board approval, the charts of female patients with endoscopic laser excision of UME were retrospectively reviewed. Demographics, clinical presentation, surgical history, pre- and post-operative Urinary Distress Inventory-6 scores and quality of life ratings, operative reports, and outcomes were obtained from electronic medical records. UME cure was defined as no residual mesh on office cystourethroscopy 5-6months after the final laser excision procedure. From 2011 to 2021, 23 patients met study criteria; median age was 56 (range 44-79) years. Twenty (87%) had multiple prior urogynecologic procedures. Median time from MUS placement to presentation with UME-related complaints was 5.3 [interquartile range (IQR) 2.3-7.6] years. The most common presenting symptom was recurrent urinary tract infection (rUTI) (n = 10). Median operating time was 49 (IQR 37-80) minutes. Median duration of follow-up was 24 (IQR 12-84) months. Fourteen (61%) required more than 1 laser excision procedure for UME. Although 5 were asymptomatic (22%), new (n = 5) or persistent (n = 8) urinary incontinence was the most common symptom on follow-up (57%). UME presenting symptoms are highly variable, necessitating a high index of suspicion in patients with a history of MUS, especially in the case of rUTI. Endoscopic laser excision is a minimally invasive, brief, safe, outpatient procedure with a high UME cure rate.

V12-07 ROBOTIC-ASSISTED TRANSABDOMINAL REMOVAL OF ERODED MID-URETHRAL MESH SLING

You have accessJournal of UrologyCME1 Apr 2023V12-07 ROBOTIC-ASSISTED TRANSABDOMINAL REMOVAL OF ERODED MID-URETHRAL MESH SLING Shreeya Popat, Gjanje Smith-Mathus, Alvaro Lucioni, and Una Lee Shreeya PopatShreeya Popat More articles by this author , Gjanje Smith-MathusGjanje Smith-Mathus More articles by this author , Alvaro LucioniAlvaro Lucioni More articles by this author , and Una LeeUna Lee More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003347.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Depending on the indication for excision, there are multiple surgical approaches for the removal of mid-urethral mesh slings: transvaginal, endoscopic, open abdominal, and robotic. In this video, we demonstrate the robotic approach to treat mid-urethral mesh slings that have eroded into the bladder. The robotic approach offers excellent exposure, visualization, and accessibility. Compared to endoscopic approaches, the entire arm of the sling can be removed from the bladder wall, the bladder repaired, and the foreign body thereby completely eliminated from the bladder. Robotic mid-urethral mesh sling excision is ideal in any patient that would be best served by maximal removal of the mesh from the bladder in order to prevent future complications. METHODS: In this video, we display two different cases to show two unique approaches to robotic mid-urethral mesh sling excision depending on the location of the mesh sling erosion: 1) If a retropubic sling is eroded through the anterior bladder, we begin by dropping the bladder and entering the space of Retzius to locate the mesh arm. 2) If the sling is eroded into the posterior bladder, a cystotomy is made on the anterior dome to visualize the posterior bladder wall. RESULTS: Once the mesh is identified, we follow the mesh graft carefully and delicately and dissect it away from surrounding tissues. The dissection is immediately close to the mesh, without fragmenting it, to allow for complete excision. This also allows for protection of adjacent critical structures. The surgical principles and instrument techniques of robotic mesh excision mirror the surgical technique utilized for transvaginal mesh excision. CONCLUSIONS: For treatment of mesh erosion into the bladder, a robotic approach offers excellent visualization, is feasible, and well-tolerated. Compared to fragmenting the mesh using an endoscopic approach, the robotic approach has the advantage of excising the mesh definitively, eliminating the foreign body in the bladder and preventing future recurrences of mesh erosion. Properly selected patients should be offered the robotic approach to mesh excision. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1066 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Shreeya Popat More articles by this author Gjanje Smith-Mathus More articles by this author Alvaro Lucioni More articles by this author Una Lee More articles by this author Expand All Advertisement PDF downloadLoading ...

Adverse Events Associated With Synthetic Male Slings: An Analysis of the Food and Drug Administration Manufacturer and User Facility Device Experience Database.

PurposeWe sought to describe and analyze the adverse events associated with synthetic male slings reported to the U.S. Food and Drug Administration (FDA) Manufacturer and User Facility Device Experience (MAUDE) database.MethodsWe queried the MAUDE database for all entries including the terms “Male Sling,” “InVance,” “Virtue,” or “Advance” from January 1st, 2009 to December 31st, 2018. We collected and analyzed information about the event type, date received, report source, source type, and manufacturer. We reviewed and categorized the event description text for each medical device report (MDR).ResultsA total of 497 adverse events related to the male sling were identified. The adverse events were classified as injury (95.4%), malfunction (4.2%), and other (0.4%). There were no deaths described. The slings involved were the Advance or Advance XP sling (69.8%), InVance (15.5%), Virtue Quadratic (12.3%), or unknown (2.4%). The 4 most common adverse events described were urinary incontinence (46.7%), sling erosion (9.1%), mechanical malfunction (8.2%), and pain/numbness (8.2%). There was no increase in the number of reports in the years following the FDA warnings for urogynecologic mesh.ConclusionsThere was an overall modest number of MDRs related to male slings and the majority of them were reported by the manufacturer. The reporting of adverse events for male slings does not seem to be affected by the controversy and scrutiny towards transvaginal mesh and midurethral slings. Further clinical studies and more objective and detailed databases are needed to investigate the safety of these synthetic slings.

Short Term Outcomes and Complications of a Single Incision Sling and Trans-Obturator Sling for the Treatment of Stress Urinary Incontinence

Study Objective To compare the efficacy of the Altis single incision sling (SIS) to traditional trans-obturator (TOT) slings for the treatment of female stress urinary incontinence (SUI). Design Single center prospective non-randomized cohort study. Setting Academic Healthcare Facility. Patients or Participants 149 patients with SUI who were undergoing a mid-urethral sling placement with a SIS or a TOT sling between March 2018 and April 2019. Interventions Placement of Altis SIS or TOT sling. Measurements and Main Results Of the 149 patients who were treated for SUI, 73 had an Altis SIS placed and 76 had a TOT sling placed. Patients completed the Incontinence Questionnaire Short Form (ICIQ-SF) and the Patient Global Impression of Improvement (PGI) Form at 3, 6 and 12 months; which reflected subjective outcomes. Objective outcome was evaluated with a cough stress test at 3, 6 and 12 month intervals. At the 3 month mark there was a statistically significant difference in both subjective and objective outcomes in favor of the Altis SIS compared with the TOT sling, (p 0.05). Subjectively there was a 88% success rate for the Altis sling and 83% for the TOT sling, with objective cure rates being 91.8% and 90.2% for the Altis SIS and TOT sling respectively. Intra-operative and postoperative complications including bleeding, transient urinary retention and pain showed no statistical significance between the 2 slings. Three sling erosion (4.1%) requiring revision were seen in the Altis SIS group compared with 1 (1.3%) in the TOT group, (p>0.05). Conclusion Findings from this study suggests that the objective and subjective outcomes as well as operative complications for the Altis SIS and the TOT sling are comparable, indicating that both slings are equally efficacious in treating patients with SUI after a short-term follow up.

Erosion of Mesh Mid-urethral Sling Into a Complex Urethral Diverticulum: Diagnosis, Evaluation, and Surgical Management

We present a case of an eroded mesh mid-urethral sling into a urethral diverticulum. Preoperative MRI and 3-dimensional translabial ultrasound aided in the identification and surgical approach. Vaginal excision of sling with urethral diverticulectomy and complex urethral reconstruction was performed. To the author's knowledge, this is the first case documented in the literature describing an eroded mesh mid-urethral sling into a urethral diverticulum.

Retrospective analysis clinical characteristics of female stress urinary incontinence and efficacy of transobturator tension-free vaginal tape procedure

Objective To explore the clinical characteristics of patients with female stress urinary incontinence(SUI) and efficacy of Transobturator Tension-free vaginal tape procedure. Methods We retrospectively analyzed the clinical data of 319 cases who were operated transobturator tension free vaginal tape in Shanghai Changhai Hospital Affiliated of Naval Medical University from Oct.2009 to Jun.2018. Patients age ranged from 39 to 91 years old, with the average age of(59.2±9.7)years old. 145(45.5%) patients aged ≥60 years old. Among them, 155 (48.6%) patients with moderate SUI, 164(51.4%) with severe SUI.96 cases(30.1%) hypertension, 24(7.5%)diabetes, 2(0.6%)had not given birth, 317(99.4%)patients had given birth more than once. 31(9.7%) coexisting pelvic organ prolapse with POP-Q stage 2 and above. Maximum urinary flow rate ranged 5.2-72.6 ml/s. Cystometric capacity ranged 56.7-1 013.6 ml. Average preoperative ICIQ-SF score was 13.9 (range 9-19). Results Operative time of 288 TVT-O procedures ranged 19-60 min, and 31 cases in the surgical management of cystocele with concomitant ranged 50-120 min. A total of 265 patients were evaluable followed up for 12-24 months, Objective cure rate and subjective cure rate were achieved in 95.8%(254 cases) and 93.6%(248 cases) respectively. POP was cured in 96.8% patients.Postoperative complications were 10.6% groin pain, 4.5% urgency, others including urinary tract infection(3.4%), de novo dysuresia(2.6%), dyspareunia(1.1%), and one case of bladder injury, one case sling erosion and one case scar hyperplasia. Conclusions Female stress urinary incontinence were mainly in middle-aged and elderly people who had severely psychological quality of life lasting for several years. TVT-O may achieve a high success or improvement rate and no serious adverse effects. One operation could correct the stress urinary incontinence and simultaneously correct prolapse. Key words: Urinary incontinence, stress; Clinical features; Transobturator tension-free vaginal tape

Translabial Ultrasound in Midurethral Sling (Mesh) Visualization and Erosion Detection in Women With Stress Urinary Incontinence: A Retrospective Pilot Study.

Sling erosion is a significant complication of midurethral sling (mesh) placement for stress urinary incontinence, a common pelvic floor disorder. The goal of this retrospective case-control pilot study was to evaluate the performance of translabial ultrasound (TLUS) and magnetic resonance imaging in diagnosing mesh erosion. Therefore, women who underwent surgery in the setting of prior failed midurethral sling for stress urinary incontinence were identified from the hospital database. The case subcohort comprised all women with intraoperatively documented erosion, and the control subcohort comprised an equal number of randomly selected patients without erosion. The data consisted of selected clinical parameters, the presence of erosion at surgery (reference standard) and at cystourethroscopy, and dual-reader preoperative TLUS consensus interpretation for mesh location (intraluminal, mural, and extramural) and erosion (defined as intraluminal or mural mesh location). Odds ratios were calculated for the selected clinical parameters. Of the 198 women identified, 15 (8%) had mesh erosion at surgery into the lower urinary tract. The sensitivity, specificity, and accuracy of TLUS and cystourethroscopy in detecting erosion in the combined group of cases and controls (30 women) were 93%, 88%, and 90%, as well as 67%, 100%, and 83%, respectively (TLUS Cohen κ = 0.85). Thus, TLUS may be a good diagnostic tool in diagnosing mesh erosion. Only 7 of 30 women had pelvic magnetic resonance examination, and mesh fragments were not visualized. Case-control comparison of the selected clinical parameters was not statistically significant.

Translabial US: Preoperative Detection of Midurethral Sling Erosion in Stress Urinary Incontinence.

Purpose To evaluate the performance of translabial (TL) US in preoperative detection of sling erosion into pelvic organs with cystourethroscopic and surgical correlation. Materials and Methods The study cohort included women who underwent surgery at a subspecialty center (from 2008 to 2016) for suspected mesh complications in the setting of previous midurethral sling placement for stress urinary incontinence (from 1999 to 2012) with available preoperative TL US imaging. Clinical information, the finding of sling erosion identified intraoperatively and at cystourethroscopy, and blinded dual-reader radiologic analysis of the TL US studies for mesh location (intraluminal, mural, or extramural) relative to pelvic organs (bladder, urethra, vagina, or rectum) were evaluated. The diagnostic performance of TL US was correlated with the reference standard of surgical findings. The consensus of two radiologists was recorded, and interobserver agreement was evaluated with the κ statistic. Results Of the 124 women who were suspected of having sling erosion (mean age, 57.5 years ± 11.1 [standard deviation]), 15 women (12.1%) had sling erosion into the urethra or bladder at surgery. Sensitivity and specificity for erosion at TL US were 53% (95% confidence interval: 45%, 62%) and 100% (95% confidence interval: 97%, 100%), respectively, when erosion was defined as only intraluminal mesh products. Sensitivity and specificity for erosion at TL US were 93% (95% confidence interval: 89%, 98%) and 72% (95% confidence interval: 65%, 80%), respectively, when erosion was defined as visualizing either intraluminal or intramural mesh products. Interobserver agreement (κ value) was 0.95. Cystourethroscopy had 67% sensitivity and 100% specificity for sling erosion. Conclusion Preoperative translabial US can be used to detect sling erosion into the lower urinary tract, with sensitivity up to 93% and specificity up to 100%. © RSNA, 2018 Online supplemental material is available for this article. See also the editorial by Benson and Phillips in this issue.

Functional follow-up after Advance® and Advance XP® male sling surgery: assessment of predictive factors.

To evaluate the efficacy of the Advance® and AdvanceXP® slings in men with stress urinary incontinence (SUI) post-radical prostatectomy and to identify predictive factors for outcome. Included were male patients with SUI following radical prostatectomy who had a positive "repositioning test", 24h-pad weight (PW) test < 400g and who were continent at night and at rest. Urgency was defined as a sudden compelling desire to pass urine, which was difficult to defer. The cure rate was defined as no pad use. From February 2008 to October 2014, 24 AdVance® and 70 AdVance XP® were implanted. The median (range) follow-up was 49 (12-102) months. The overall cure rate was 77%. The preoperative 24h PW was significantly related to the continence outcome (p = 0.044). A total of 12 patients (13%) presented with postoperative AUR, which was significantly related to abnormal voiding detrusor activity (p = 0.036). Twenty-two patients (23%) had postoperative urgency (16% "de novo"), which was significantly related to preoperative urgency (p = 0.003). During follow-up, a degree of deterioration of continence was observed in five patients who were classed as cured initially. To date, no reports of urethral sling erosion have been made. The AdVance® and AdVanceXP® slings are safe and effective in relieving SUI following post-radical prostatectomy. There were no differences between the two slings in terms of efficacy, urgency or postoperative AUR. There was a moderate rate of "de novo "urgency and low rate of loss of continence during follow-up.

Erosion of Polytetrafluoroethylene (Gore-tex) Sling Over 20 Years After Placement for Stress Urinary Incontinence

As synthetic material has evolved to improve both the efficacy and biocompatibility of suburethral slings, soft polypropylene slings are currently the gold standard for treatment of stress urinary incontinence. However, reports of complications beyond 10 years are limited and patients can nevertheless present with erosion and other complications from other sling materials that have been used in the past. We present a case of synthetic sling erosion 21 years after placement of a polytetrafluoroethylene sling (Gore-tex).

Surgical treatment of massive bleeding of a right aberrant subclavian artery after oesophageal stent removal

Abstract We report a case of a 9-year-old female who required surgical treatment and resuscitation after severe transoesophageal bleeding of a right aberrant subclavian artery (RASA). Bleeding of this RASA was caused by a mechanical irritation due to an oesophageal stent. The stent was placed weeks before to dilate the oesophagus after accidental ingestion of a caustic agent. Although conservative management of benign oesophageal stenosis in children is highly recommended, there are still some major complications to be considered. To avoid erosion of aberrant subclavian artery vascular rings and slings, as described in several case reports, these vessels should be excluded by computed tomography (CT) or magnetic resonance imaging (MRI) scans before placement of oesophageal stents. This case suggests that management of caustic ingestion in children is still a major challenge in paediatric surgical departments.

Pelvic floor ultrasound in the diagnosis of sling complications.

The mid-urethral synthetic sling (MUS) procedure has become the standard of care for treatment of female stress urinary incontinence. However, a small number of patients will have complications following MUS including failure, obstructive voiding, sling erosion, or chronic pain. This paper discusses the role of 2D and 3D ultrasound imaging in the evaluation of the female patient with complications following placement of a synthetic mid-urethral sling. The MUS is easily visualized as an echogenic structure on ultrasound and can be imaged by transperineal, transvaginal and introital approaches. Ultrasound allows dynamic assessment of the sling and can assist in the diagnosis of sling failure, obstruction, erosion and mesh related pain. Pelvic floor ultrasound has an emerging role in the assessment of complications following MUS surgery. 3D ultrasound can assist the clinician in assessment of the complex patient with multiple slings or meshes in situ.

P07.10: Transperineal 3D pelvic ultrasound in the assessment of complex voiding dysfunction following failed suburethral sling division surgery

The mid-urethral synthetic sling (MUS) is the most commonly performed surgical procedure in the treatment of female stress urinary incontinence. We aimed to evaluate the utility of transperineal 3D ultrasound (TPUS) in the assessment of complex patients with persisting voiding dysfunction following sling division surgery. 12 patients with persisting voiding dysfunction post MUS division underwent TPUS using Philips IU22/ EPIQ ultrasound machines and X6-1MHz Matrix transducer. Dynamic 2D imaging was performed at rest and on Valsalva in supine, sitting and standing positions. 3D volume datasets were obtained and off-line analysis performed on Qlab software. Of 12 patients with persisting symptoms post sling division, 9 had 2 slings in situ and 2 had pubovaginal fascial sling. All had undergone previous transvaginal surgery to relieve obstruction (8 had division of sling,4 had excision of a suburethral sling segment). Dynamic compression of the urethra by sling was observed on 2D imaging in all patients. 10 of 12 patients had overangulation/distortion of urethral axis due to the obstructive sling (8 synthetic, 2 fascial), 3 of whom were demonstrated only when scanned in sitting position. 3D volume analysis showed 2 patients had sling erosion into urethra and 2 had vaginal erosion. In 3 patients who had undergone excision of a suburethral sling segment, 3D volume analysis showed there was incomplete excision with a small amount of sling continuity. 10 patients subsequently underwent urethrolysis with excision of a suburethal sling segment and resolution of voiding dysfunction. Transperineal 3D Ultrasound has a useful role in the assessment of complex patients with persistent voiding dysfunction post sling division, especially in those with multiple slings in situ. Our findings suggest that incision of an obstructive sling may not adequately relief obstruction and excision of a sub-urethral portion of sling may be preferable.

Are complications of stress urinary incontinence surgery procedures associated with the position of the sling?

To evaluate whether the sling position is associated with particular types of complications in patients undergoing suburethral sling placement for stress urinary incontinence. Data from 100 women diagnosed at the Evangelical Hospital Hagen-Haspe with complications after suburethral sling insertion were analyzed. All patients underwent pelvic floor ultrasound to assess: urethral length, sling location in relation to the urethral length (%) and the sling distance to the longitudinal smooth muscle complex of the urethra (the sling-longitudinal smooth muscle distance). The shortest median sling-longitudinal smooth muscle distance was observed in patients with recurrent urinary tract infections, urinary retention and overactive bladder: 0.9, 1.1 and 1.75 mm, respectively (P < 0.05). In women with persistent stress urinary incontinence and sling erosion, the sling-longitudinal smooth muscle distance was 3.6 and 4.6 mm, respectively (P < 0.05). Persistent stress urinary incontinence was connected with the position of the sling in relation to the bladder neck - in these patients, the sling was closer to the bladder neck. Sling location plays a pivotal role in the occurrence of certain complications. The sling position in the proximal part of the urethra or between the middle and proximal urethra appears to be connected with a high rate of unsuccessful stress urinary incontinence treatment. A sling-longitudinal smooth muscle distance below 2 mm is often connected with sling complications, such as overactive bladder, urinary retention and recurrent urinary tract infections.

Autologous Pubovaginal Sling for the Treatment of Concomitant Female Urethral Diverticula and Stress Urinary Incontinence

To describe our experience with concomitant repair of urethral diverticula and stress urinary incontinence (SUI) with autologous pubovaginal sling (PVS). A retrospective chart review between January 2006 and 2013 identified 38 women undergoing concomitant diverticulectomy and rectus sheath PVS. Patient demographics, presenting symptoms, prior urethral surgery, concomitant procedures, postoperative outcomes, and complications were evaluated. The mean duration of symptoms was 56.7 months. Eleven patients presented with recurrent diverticula and 5 patients had prior SUI surgery (3 midurethral slings, 1 PVS, and 1 bulking agent). One patient had a prior urethrolysis. All other slings were cut or excised at the time of surgery. All women had demonstrable SUI on cough stress test or urodynamics. The mean follow-up was 12.7 months. All postoperative voiding cystourethrograms were negative for contrast extravasation. One patient required prolonged (>4 weeks) suprapubic tube drainage for urinary retention. Four others required an additional 1 week of suprapubic tube drainage. Eighteen patients (47%) reported mixed urinary symptoms. Of these, 9 had complete resolution, whereas 9 experienced significant improvement. Overall, 97.3% reported resolution of their dysuria, dyspareunia, and pain symptoms and 90% reported complete resolution of their SUI symptoms. There were 2 urethral diverticula recurrences and 2 SUI recurrences. Perioperative complications, including hemorrhage, sling erosion, or urethrovaginal fistulas, were not observed. Concomitant PVS placement is a safe and effective treatment option for SUI in patients undergoing urethral diverticulectomy. The risks and benefits should be weighed and management individualized.

Robotic Approach to Excision of a Recurrent Retropubic Sling Erosion into the Bladder

Robotic Approach to Excision of a Recurrent Retropubic Sling Erosion into the Bladder

Laparoscopic Retropubic Mesh Excision

To demonstrate laparoscopic techniques in the retropubic space for excision of mesh. This video describes the surgical management of a vaginal mersilene sling erosion. Conservative management with trimming in the office had failed to relieve her symptoms of vaginal discharge and post-coital spotting. In view of the risk of chronic infection of remaining mersilene mesh, decision was made to remove the entire sling. The vaginal portion is addressed first with both arms being freed up to the symphysis pubis. Laparoscopically, the mesh is dissected while still attached to the abdominal fascia. This allows the fascia to act effectively as a third arm, providing traction superiorly. Once fully dissected, the mesh is transected close to the fascia and removed by traction vaginally. These minimally invasive techniques may be applied when addressing complications arising from various mesh procedures in the retropubic space. Laparoscopic techniques may be used to effectively remove mesh from the retropubic space, overcoming disadvantages of an open approach.

Excision of Mid-Urethral Sling Erosion with Large Bladder Neck Stone

Excision of Mid-Urethral Sling Erosion with Large Bladder Neck Stone