A laparoscopic approach for excision of urethral erosion of midurethral polypropylene sling

Stratta E1, Goodall E1, Cartwright R1, Jackson S1, Price N1

Research Type

Clinical

Abstract Category

Urethra Male / Female

Abstract 292
Surgical Video 1
Scientific Podium Video Session 17
Thursday 30th August 2018
09:36 - 09:45
Hall D
Grafts: Synthetic Pain, other Stress Urinary Incontinence Surgery Anatomy
1. John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust
Presenter
E

Emily Stratta

Links

Abstract

Introduction
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.
Design
We demonstrate a laparoscopic approach for the complete removal of a mid-urethral retropubic sling eroding into the urethra.
Results
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.
Conclusion
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.
References
  1. Neurourol. Urodyn. 27, 491–495 (2008)
  2. BJU Int. 108, 1472–1478 (2011)
Disclosures
Funding None to declare Clinical Trial No Subjects Human Ethics not Req'd Case report Helsinki Yes Informed Consent Yes