Radical excision of a complicated transobturator tape
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IUJ VIDEO
Radical excision of a complicated transobturator tape Themos Grigoriadis 1 & Dimitrios Zacharakis 1 Nikistratos Vogiatzis 1 & Stavros Athanasiou 1
&
Vasileios Kontogeorgakos 2 & Athanasios Protopapas 1 &
Received: 25 May 2019 / Accepted: 16 September 2019 # The International Urogynecological Association 2019
Abstract Aim of the video In this video, we present the case of a late-detected sinus formation 4 years after a TOT placement. Method A combined surgical approach (transvaginal and transcutaneous routes) performed by a urogynecologist and an orthopaedic surgeon was chosen to carry out a radical en bloc excision of the sinus tract with the right half of the tape. This combined approach has the advantage of completely removing the biofilm adhered to the surface of the tape and the surrounding tissues, thus making antibiotic therapy more effective. Conclusion Surgical removal of these microbial commmunities is very important for the resolution of device-related infections. Severe infectious complications of transobturator slings should be managed by a tertiary multidisciplinary team to optimize patient care. Keywords Transobturator tape . Midurethral sling . Biofilm . Infection . Tape excision . Sinus
Aim of the video Placement of midurethral slings (MUS) such as the retropubic (TVT) and the transobturator (TVT-O, TOT) is currently the most common procedure for the surgical treatment of stress urinary incontinence (SUI) [1]. The intra- and postoperative complication rates following placement of MUS are low, while the transobturator approach has been found to have significantly lower rates of urinary tract injuries [2]. Nonetheless, late-detected complications specifically related to transobturator MUS such as thigh abscesses [3], sinuses [4] and necrotizing fasciitis [5] are associated with major Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00192-019-04127-0) 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.’ * Dimitrios Zacharakis [email protected] 1
First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, “Alexandra” General Hospital, 80 Vas.Sofias Aven, 11528 Athens, Greece
2
First Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, ATTIKON University Hospital, Athens, Greece
morbidity and are probably underreported in the literature [2]. Management of such complications is complex and may require aggressive surgical treatment including total mesh removal. In this video, we present the case of a late-detected sinus 4 years after a TOT placement, which was treated with en bloc excision of the right arm of the tape and the sinus tract.
Method A 39-year-old woman was referred to our department complaining of increasing pain in her right thigh, which was followed by leakage of pus in the region of the r
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