The Management and Efficacy of Surgical Techniques Used for Erosive Mesh in the Urethra and Bladder: A Systematic Review

Sobota, Rosanna; Thomas, Dominique; Demetres, Michelle; Cadestin, Vickie; Mao, Tsung; Asfaw, Tirsit; Chughtai, Bilal

doi:10.1016/j.urology.2019.08.001

Cited by 4 publications

(5 citation statements)

References 19 publications

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“…Conservative management strategies such as local oestrogen or long-term low-dose antibiotics for recurrent UTIs are associated with a 100% risk of persistence or recurrence of urethral perforation, according to a recent systematic review [16,18]. Different approaches have been described for the excision of an eroded mesh into the urinary system, including open trans-vaginal or abdominal, laparoscopic, robotically assisted, cystoscopic resection with electrode loop or endoscopic scissors and trans-urethral approach with laser excision [19]. The systematic review by Sobota et al [19] analysed the safety and efficacy of cystoscopic vs. open and/or laparoscopic removal of erosive meshes into urethra or bladder on a cohort of 177 patients from year 2000 to 2015.…”

Section: Discussionmentioning

confidence: 99%

“…Different approaches have been described for the excision of an eroded mesh into the urinary system, including open trans-vaginal or abdominal, laparoscopic, robotically assisted, cystoscopic resection with electrode loop or endoscopic scissors and trans-urethral approach with laser excision [19]. The systematic review by Sobota et al [19] analysed the safety and efficacy of cystoscopic vs. open and/or laparoscopic removal of erosive meshes into urethra or bladder on a cohort of 177 patients from year 2000 to 2015. Their study highlighted more complete symptom resolution in the urethral erosion cohort for a vaginal surgical approach compared with a cystoscopic approach (63 vs. 56%, respectively), even if 32% of the cystoscopic group reported overall 'improved' symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…The PICO statement for this systematic review is as follows: in patients submitted to synthetic sling procedures for STU who experienced mesh erosion into the urinary system (bladder and/or urethra), what is the success rate of cystoscopic laser excision in terms of complete mesh removal proven during a follow-up cystoscopy after a single or additional procedures [11–39].…”

Section: Methodsmentioning

confidence: 99%

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Should endoscopic laser excision be offered as the first-line management for patients with eroded mesh? Outcomes of a systematic review of literature

Ripa,

Enikeev,

Talyshinskii

et al. 2023

Current Opinion in Urology

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Purpose of review Mesh erosions following previous synthetic sling/mesh surgery for stress urinary incontinence (SUI) have become increasingly common. This systematic review provides evidence for the role of laser excision as a first-line management in patients with eroded mesh. Recent findings Fourteen articles (173 patients) were included for the final review. Among these, 138 patients (79.8%) were submitted to trans-urethral laser excision of eroded urethral/bladder mesh over a median time to presentation of 36.6 months. Over a median follow-up of 23.6 months, 88 (63.7%) reported a complete resolution, 32 (23.2%) reported persistence or recurrence of SUI and 17 (12.3%) presented with recurrent mesh erosion. The success rate after a single endoscopic procedure was 66.5, vs. 93.5% after additional endoscopic procedures, with only 9 (6.6%) requiring open surgical excision. Overall, there were seven (5.1%) postoperative complications including two urethrovaginal fistulas, two UTIs and haematuria each, and one case of urethral diverticulum. Summary Laser excision of eroded mid-urethral slings into either the bladder or urethra is a challenging complication of minimally invasive incontinence surgery. Laser excision was able to achieve a good success rate with single or staged endoscopic procedure with a low risk of complication. It represents a valid first treatment option, although patients should be managed in mesh referral centres in collaboration with uro-gynaecology teams.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Should endoscopic laser excision be offered as the first-line management for patients with eroded mesh? Outcomes of a systematic review of literature

Ripa,

Enikeev,

Talyshinskii

et al. 2023

Current Opinion in Urology

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“…Transobturator mesh tape (TOT) 33% (11) Retropubic tension-free vaginal tape (TVT) 55% (18) Unknown 3% (1)…”

Section: Mesh Type (N = 33) Amentioning

confidence: 99%

“…Endoscopic mesh removal may have a relatively good success rate in the short term as was shown in a recent systematic review by Sobota et al, wherein only 22% (collated sample size = 41) of patients required a repeat cystoscopic treatment of their eroded mesh. 11 However, the median follow‐up time was 6 months ± 17.0 (range 1–65 months), highlighting that long‐term evidence was limited.…”

Section: Introductionmentioning

confidence: 98%

Cystoscopic removal of transvaginal mesh: Long‐term outcomes

Anderson,

Perrouin‐Verbe,

Bridgeman‐Rutledge

et al. 2023

BJUI Compass

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ObjectivesThis study's aim is to evaluate the long‐term quality of life and functional outcomes following cystoscopic excision of stress urinary incontinence (SUI) and pelvic organ prolapse (POP) mesh extruded into the urinary tract in women.Patients and MethodsA retrospective chart review was performed of all cases of cystoscopic removal of extruded mesh at our high‐volume tertiary care centre between April 2013 and August 2021. Postoperative patient‐reported outcomes were collected via questionnaires: Urogenital Distress Inventory Short Form (UDI‐6), EQ‐5D‐5L Visual analogue scale, ICIQ‐Satisfaction (ICIQ‐S) and additional questions regarding postoperative sexual function.ResultsDuring the study period, 27 women with a median age of 61 years (45–87) underwent cystoscopic mesh removal surgery using either Ho‐YAG laser (56%) or bipolar loop resection (44%). The most common presentation of mesh extrusion was recurrent urinary tract infections (67%). Other presenting complaints were pain (41%), urinary urgency ± incontinence (41%) and voiding difficulties (18%). Long‐term follow‐up outcomes from 20 patients (median follow‐up: 24 months) showed that mesh removal was rated successful by 80%, and 100% would choose to have the surgery again if in the same situation. Recurrent SUI was reported by 45% of respondents, and urinary urge incontinence was found in 50%. For patients who answered the sexual function questions, 50% reported improved sexual function postmesh removal (6/12).ConclusionsCystoscopic removal of extruded female SUI and POP mesh is associated with high patient satisfaction and low morbidity in appropriately selected patients at 2‐year median follow‐up. A patient‐centred shared decision‐making process is essential in counselling patients regarding options and expected outcomes following mesh removal surgery.

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