Management of intravesical mesh erosion post tension free vaginal tape : Transurethral resection – a single center experience

Lin C1, Chueh K2, Huang T1, Wu Y1

Research Type

Clinical

Abstract Category

Female Stress Urinary Incontinence (SUI)

Abstract 783
Non Discussion Abstract
Scientific Non Discussion Abstract Session 37
Female Surgery Stress Urinary Incontinence
1. Kaohsiung Medical University, Kaohsiung, Taiwan AND Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, 2. Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
Links

Abstract

Hypothesis / aims of study
The tension-free vaginal tape (TVT) has gained acceptance as an effective surgical treatment of female stress incontinence. It is minimally invasive technique with a short operative period, rapid recovery and superior cure rate. However, this procedure is not without potential for complications. We reported case series of bladder erosion; synthetic tape materials into bladder wall, and we describe successful endoscopic management of the intravesical propylene mesh.
Study design, materials and methods
From August 2010 to May 2017, four patients were recorded with intravesical erosion post tension-free vaginal tape (TVT) procedure. These records were reviewed to the text on presenting symptoms, length of follow-up and outcomes. All the patients had a tension-free vaginal tape implanted at other department and were later referred to our department for surgical intervention.
Cystoscopy were performed in all four cases and the examination revealed a foreign body, suspect mesh material at the bladder wall with local inflammatory changes. Other diagnostic evaluations were also performed included past history record, physical examination, urine analysis, and transabdominal sonography. For materials removal, the standard transurethral resection of the partial mesh, surrounding bladder mucosa was performed in these cases (Fig) The depth of resection was into bladder wall till deep muscle layer. The 26Fr. resectoscope introduced with a 30-degree telescope. The depth of resection was into bladder wall till deep muscle layer. The resection was repeated to confirm the intravesical and intramural part of the mesh could be removed. 
All patients were under general anesthesia. After the operation, 18Fr. Foley catheter was indwelled and removal 3 days after. All of them had cystoscopy follow-up after 3-4 months later.
Results
Their age were 58-67 years old, and the interval between the tension-free vaginal tape procedure and the complication onset were varied. The definite onset timing was difficult to evaluate. The time of patient’s complaining was figured as the onset of tape erosion exacerbation. All these patients had symptom of Recurrent Urinary tract infection, and some of them combined with gross hematuria, and urgency. Cystoscopy was performed in these four, and bladder erosion by transvaginal tape with calcification formation. The follow-up cystoscopy revealed bladder wall scar without perforation in all patients, and 3 of them denied recurrent urinary incontinence. A patient complained of incontinence and the symptom was improved after pelvic floor exercise training.
Interpretation of results
Tension-free vaginal tape is considered as a minimally invasive and safe surgical technique. However, the rare complication of bladder erosion should be noticed. The intravesical foreign body can induce encrustation and usually go with recurrent urinary tract infection. The symptom of recurrent urinary tract infection with lower urinary tract symptoms after tension-free vaginal tape must be considered that it may be the result of bladder erosion and the diagnosis can be confirmed by cystoscopy. 
For intravesical erosion, transurethral approach is reliable treatment and provides a good outcome. After the procedure of partial mesh excision by standard transurethral resection, no urinary incontinence was recorded in the most of patients within follow-up. Cystoscopy at the 3-month follow-up revealed complete healing of the bladder mucosa, and no symptoms of urinary tract infectionwere complained in all patients during the follow-up. In our opinion, the transurethral resection of the partial mesh is acceptable and effective treatment. We thought the residual part of tape and fibrosis tissue may provide enough tension in the midurethra, acting as a hammock-like support to avoid recurrent urinary incontinence.[1] Further studies are necessary for this hypothesis
Concluding message
Although the incidence of tension-free vaginal tape bladder erosion is rare, post procedure symptoms, such as recurrent urinary tract infection, may be considered the sign of mesh erosion into bladder. In our opinion, standard transurethral resection of partial mesh is a safe, and effective treatment option for erosion mesh removal.
Figure 1 Table 1. Patient profile
Figure 2 Figure 1.
References
  1. Oh, T.-H., & Ryu, D.-S. (2009). Transurethral Resection of Intravesical Mesh After Midurethral Sling Procedures. Journal of Endourology, 23(8), 1333–1337. doi:10.1089/end.2009.0098
Disclosures
Funding Nil Clinical Trial No Subjects Human Ethics not Req'd All of these data were recorded from our clinical practice, and all patient agrees to provide their health record. Helsinki not Req'd This is a retrospective observation case series report Informed Consent Yes