Urethra Male / Female
Tension-free mid-urethral sling insertion for the management of urinary stress incontinence has serious but rare complications. Urethral polypropylene sling erosion occurs in 0.07-1.5% cases. Various vaginal and cystoscopic techniques have been described for excision of mesh eroding the urethra, including use of cystoscopic trimming(1), or ablation with a holmium laser(2), all of which carry a high risk of recurrence of erosions.
We demonstrate a laparoscopic approach for the complete removal of a mid-urethral retropubic sling eroding into the urethra.
Cystourethroscopy demonstrated polypropylene mesh erosion in to the posterior urethral wall with stone formation over the mesh. There was no bladder erosion identified. At laparoscopy, the retropubic space was opened and bladder reflected to visualise the urethra. The mesh arms were identified bilaterally and dissected down to the level of the urethra. The mesh was removed in its entirety from urethral wall using traction and blunt dissection. The urethra was repaired using monofilament suture. There was no narrowing of the urethral lumen post-operatively and urethral function was preserved. At 2-year follow up cystourethroscopy the bladder and urethra were normal in appearance.
We describe a novel case of excision of eroded urethral polypropylene sling via the laparoscopic approach. This patient had a good long term outcome from her surgery, with no recurrence of the erosion, no de novo voiding difficulties, and preservation of the urethral continence mechanism. The laparoscopic approach should be considered as a feasible alternative to a vaginal or cystoscopic approach.