Reoperation After Complicated Tension-Free Vaginal Tape Procedures

Wyczółkowski, Marek; Klima, Wlodzimierz J.; Piasecki, Z

doi:10.1097/00005392-200109000-00058

Cited by 3 publications

(1 citation statement)

References 2 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, there are two reports of failed endoscopic removal of cut but adherent tape requiring an open procedure [8,28]. Bladder stones are crushed mechanically or with the lithoclast, while tape is either cut flush with the bladder wall and extracted whole, or resected.…”

Section: Discussionmentioning

confidence: 99%

Unrecognized bladder perforation with mid‐urethral slings

2010

View full text Add to dashboard Cite

Study Type – Therapy (case series) Level of Evidence 4OBJECTIVETo present a series of women with late presentation of mid‐urethral synthetic slings perforating the bladder and their management, this is rare but can lead to significant morbidity with medico‐legal consequences.PATIENTS AND METHODSWe retrospectively reviewed the case notes of nine women with urinary symptoms referred to our unit for further investigation after synthetic mid‐urethral sling placement.RESULTSThe women presented between 8 weeks and 18 months after initial sling placement. Eight patients underwent a tension‐free vaginal tape insertion via the retropubic route and one patient had an ‘outside‐in’ obturator sling with the I‐Stop device (CL Medical, Lyon, France). The frequencies of presenting symptoms were: dysuria in six; recurrent urinary tract infection in four; frequency and urgency in four and pelvic pain in two. Seven of the nine women developed bladder calculi on the exposed sling material, all of which were visible on plain X‐ray. In six women, perforations were present at more than one site; in three urethral perforation had occurred together with an anterolateral bladder injury and in the remaining three there was bilateral bladder perforation. Initial management included cystoscopy and cystolithopaxy followed by transurethral resection (TUR) of the visible prolene mesh into the detrusor muscle. One woman required two TURs to clear all the mesh. Two women required further open surgery to remove all of the remaining mesh, both for ongoing pelvic pain that resolved after revision surgery. All the women had resolution of symptoms but all had recurrent stress urinary incontinence after tape division/excision. We used a novel technique to remove intraurethral mesh using a nasal speculum urethrally and excising the tape under direct vision, where resection proved impossible due to poor endoscopic views, with significant risk of sphincter injury.CONCLUSIONSThe possibility of unrecognized tape perforation or erosion must be considered in women with persistent urinary symptoms, infection or pain after any form of mid‐urethral sling procedure. Bladder stones almost invariably develop if the exposed mesh has been present for >3 months. Most patients can be managed with endoscopic resection to remove all intravesical tape. Cystoscopy should remain a mandatory procedure together with any form of mid‐urethral sling placement but does not prevent unrecognized perforations in inexperienced hands.

show abstract

Section: Discussionmentioning

confidence: 99%

Unrecognized bladder perforation with mid‐urethral slings

2010

View full text Add to dashboard Cite

show abstract

Intravesical tape erosion following the tension‐free vaginal tape procedure for stress urinary incontinence

Negoro¹,

Kawakita²,

Imai

2005

Int J of Urology

View full text Add to dashboard Cite

We report a case of intravesical tape erosion which occurred 6 months after the tension-free vaginal tape (TVT) procedure, which was successfully treated by partial tape removal. A 75-year-old woman, who had complained of recurrent cystitis after TVT procedure, was referred to Kobe City General Hospital in August 2003. The intravesical tape erosion was revealed by cystoscopy and computed tomography, and the tape was removed with a retropubic approach. The recurrent cystitis has been cured and the stress urinary incontinence has not recurred. The intravesical tape erosion was rare, with only seven reported cases including the present case.Key words tension-free vaginal tape, complications, erosion, bladder. Case reportA 75-year-old woman, who had a history of oophorectomy for an ovarian cyst, was referred to our department due to recurrent urinary tract infections 6 months after the TVT procedure performed elsewhere for type 2 stress urinary incontinence. In the TVT operation, the bladder was perforated twice, which induced urinary leakage and abscess formation in the anterior vesical space. Though open drainage had ameliorated the extravesical infection, the patient had complained of vesical irritability and pneumaturia since 1 month after the TVT procedure. The urinalysis showed pyuria and microscopic hematuria. The urine culture revealed the ampicillin-resistant E. coli at 10 5 CFU/mL. Computed tomography (CT) disclosed gases in the bladder and in the thick bladder wall (Fig. 1). A cystogram did not show any vesicointestinal fistulae. Cystoscopy revealed mucosal erosion in the bulged bladder wall at the left lateral side (Fig. 2).We performed the open resection of the tape using a retropubic approach. The tape was severely adhered to the scarred tissue including the peritoneum and the bladder wall. The left side of the tape was resected at the side of the urethra. The bladder was closed with interrupted absorbable sutures. Histopathology showed the necrosis of the bladder wall (Fig. 3).The Foley catheter was indwelling for 7 days and the patient was discharged on postoperative day 10 without complications. No sign of urinary tract infection or recurrence of stress urinary incontinence was apparent in follow up for 10 months. DiscussionIt is estimated that more than 250 000 tension-free vaginal tape procedures have been performed for stress urinary incontinence since 1997.1 The TVT procedure was based on the integral theory that the urethra and the vagina were suspended like a hammock by tendons and muscles in the pelvic floor. Under abdominal pressure, the urethra was closed at its middle part.2 It is minimally invasive and can be performed under local anesthesia, so a short hospital stay is possible. But the procedure includes the blind manipulation of inserting the TVT

show abstract

Transobturator surgery for female stress incontinence: a comparative anatomical study of outside‐in vs inside‐out techniques

2007

View full text Add to dashboard Cite

For unknown reasons, the English translation of the earlier version of this report (published in Progrès en Urologie ) was not published as promised in European Urology. Since 2005 several publications have confirmed our observations and were therefore cited in the text in addition.specimens had a tape inserted outside-in on one side, and inside-out on the other; of the remaining two cadavers, one had an insideout tape and one an outside-in tape, bilaterally. After tape insertion, the cadavers were dissected. Particular attention was paid to the distances between the tape and the deep external pudendal vessels, and between the tape and the posterior branch of the obturator nerve. RESULTSWith the inside-out technique, the safety margins were reduced, and the external pudendal vessels and the posterior branch of the obturator nerve were at greater risk of injury. CONCLUSIONThe two techniques are not equivalent, with a lower risk of injury to vascular and nerve structures with the outside-in technique. KEYWORDSobturator foramen, urinary incontinence, surgery, complications Study Type -Prognosis (outcomes research) Level of Evidence 2c OBJECTIVETo assess the specific risks of injury to neural and vascular structures inherent in two approaches to transobturator surgery for inserting a suburethral sling, i.e. the outsidein (standard technique) and inside-out approaches.

show abstract

Reoperation After Complicated Tension-Free Vaginal Tape Procedures

Cited by 3 publications

References 2 publications

Unrecognized bladder perforation with mid‐urethral slings

Unrecognized bladder perforation with mid‐urethral slings

Intravesical tape erosion following the tension‐free vaginal tape procedure for stress urinary incontinence

Transobturator surgery for female stress incontinence: a comparative anatomical study of outside‐in vs inside‐out techniques

Contact Info

Product

Resources

About