Female Stress Urinary Incontinence (SUI)
Bum Sik Tae
Perforation of the bladder or urethra and erosion of the mesh after cystocele repair surgery are not uncommon and have potentially serious complications. Traditionally, surgical management of such complications has involved excision of the mesh using either a transurethral approach or open surgery. However, incomplete excision can cause erosion, stone recurrence, and bladder wall scarring. In this video, we present our experience of laparoscopic transvesical surgery for exposed mesh and stone.
Patient was placed in the lithotomy position under general anesthesia and a 30° operating cystoscope was inserted under direct vision. After filling the bladder with 300 mL normal saline, a 5-mm VersaStepTM bladeless trocar was placed 2 cm above the pubic symphysis. Two more 5-mm trocars were placed bilaterally at 3-cm intervals from the initial trocar site. The pneumovesicum state was maintained at 8–12 mmHg and a 5-mm telescope was introduced. Using a curved dissector and curved Mayo scissors, the exposed mesh was mobilized from the paravesical tissue and removed, including the muscle and mucosa layer. Interrupted 4-0 Vicryl sutures were used to close the defect in a single layer. To localize the ureteral orifice, intravenous Indigo Carmine was used. The bladder stones were removed through the urethra using a stone basket, guided using a ureteral stent pusher.
Total operation time was 55 min and the Foley catheter was removed 5 days after surgery.
Excellent visualization of mesh exposure and ureteral orifice was possible in laparoscopic transvesical surgery, and reconstruction with interrupted sutures, including the mucosa and muscle layer was able to be achieved.