A novel technique for complete laparoscopic excision of a transobturator sling with lower urinary tract mesh erosion
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IUJ VIDEO
A novel technique for complete laparoscopic excision of a transobturator sling with lower urinary tract mesh erosion Aditi Siddharth 1
&
Mohammed J. Hussain 2 & Rufus Cartwright 1 & Simon Jackson 1 & Natalia Price 1
Received: 13 October 2019 / Accepted: 11 February 2020 # The International Urogynecological Association 2020
Abstract Introduction and hypothesis To demonstrate a novel technique for complete laparoscopic removal of a transobturator sling for mesh erosion involving a large area of the urethra and bladder neck, without the need for concomitant vaginal dissection. Method A 56-year-old woman had a transobturator sling inserted for stress urinary incontinence (SUI) in 2009. In 2017, 8 years following surgery, she experienced groin pain, exacerbated by exercise, and developed recurrent urinary tract infections with dysuria and urethral pain. A cystoscopy demonstrated mesh erosion from the midurethra to bladder neck with a 2-cm calculus formed around the mesh. After careful counselling and discussion at a multi-disciplinary meeting, a decision was made to proceed with laparoscopy with a view to remove the mesh completely. The mesh was removed from the points of erosion into the urethra through a total laparoscopic procedure. The patient made a good recovery with no ongoing pain or voiding difficulties. Conclusion Combined approaches for complete excision of transobturator slings, including bilateral inguinal dissection, are relatively morbid with prolonged recovery time and in most centres will require involvement of plastic surgeons. The laparoscopic approach not only allows for the mesh to be removed in total (including the intramural portion of the mesh), but also provides magnified views compared with open surgery and thus allows for better identification of planes and dissection. It also has the added benefit of avoiding vaginal incisions and therefore reducing the risk of fistula formation between the urethra/ bladder and vagina. Keywords Mesh erosion . Laparoscopic approach . Transobturator tape
Aim of video To demonstrate a novel technique for complete laparoscopic removal of a transobturator sling for mesh erosion involving a large area of the urethra and bladder neck, without the need for concomitant vaginal dissection. Polypropylene midurethral slings have been widely used for management of stress urinary Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00192-020-04264-x) contains supplementary material. This video is also available to watch on http://link.springer. com/. Please search for this article by the article title or DOI number, and on the article page click on ‘Supplementary Material’. * Aditi Siddharth [email protected] 1
John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, UK
2
Milton Keynes Hospital NHS Foundation Trust, Standing Way, Eaglestone, Milton Keynes MK6 5LD, UK
incontinence (SUI). However, common short- and long-term complications have been reported, including visceral injury and chronic
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