Transvesical laparoendosopic single-site surgery as a valuable option to remove eroded materials from the bladder: single-center experience and a review of the literature

Abstract

Introduction Currently, polypropylene materials are used widely for the treatment of various urogynecologic disorders. This type of treatment can be complicated, although rarely, with erosions of the polypropylene implants into the bladder or the urethra. There is no established treatment for such complications. We present our experience in transvesical laparoendoscopic single-site surgery (T-LESS) removal of eroded materials, and a review of the literature in this field. Materials and methods From June 2015 to May 2017 eight females, with an average age of 66.5 years (range 55–80 years), were referred to our Center because of the erosion of polypropylene material in the bladder, after anti-incontinence or pelvic organ prolapse treatment. Patients were diagnosed with ultrasound and cystoscopy. Seven bladder erosions and one bladder and urethral penetration were found. Patients were qualified for removal with the T-LESS approach. The Tri-Port + disposable set and standard laparoscopic instruments were used. The eroded materials were dissected and cut away, and the defects of the bladder wall were closed with barbed sutures. The peri-operative efficacy and safety of the method were assessed, and the patients were scheduled for follow-up visits at 6 weeks and every 3 months thereafter. The patients were offered a cystoscopic exam during the 7–10 month period after the operation. Results The procedures were completed successfully in all patients. No blood loss or complications were observed. The mean operative time was 54.5 min, and the average hospital stay was 30 h. During a follow-up at 11 months, all patients were cured, except for one who presented urethral erosion. Conclusions The T-LESS technique for removal of eroded meshes is a safe and effective method. The precise access to the bladder minimizes morbidity, and suturing the bladder wall defects may reduce the risk of recurrence.

Pneumovesicoscopic management of bladder neoplasms in children: three case reports

“…Anyway, this technique continued to find applications and, since 2005, many kinds of surgical interventions were performed in children with pneumovesicoscopy, such as ureteral reimplantation for vesicoureteral reflux, and other indications. 12 Papilloma is a benign exophytic lesion characterized by papillary fronds classified into urothelial bladder neoplasms (UBN). A recent study by Berrettini et al 2 cystoscopic resection of UBN performed in 18 patients.…”

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

“…However, laparoscopic approach is not devoid of complications, such as retropubic haematoma, which may require evacuation, urinary sepsis, visceral and neurovascular injuries, surgical site infections, incisional hernias and risk of recurrent incontinence [22,23]. In 2018, a combined transvesical and laparo-endoscopic single-port technique was used to treat eight patients with eroded MUS into the bladder [24]. This approach relies on the percutaneous insertion into the bladder of a singleport under direct cystoscopic visualization, followed by the induction of pneumovescicum with carbon dioxide, with simultaneous trans-urethral access with graspers or suction.…”

“…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].…”

Biocompatible Elastomer with Adjustable Mechanical Properties and Degradation Rate as a Midline Segment of Bipartite Sling

“…In 2008, around 127 million women and 10 million men were affected [7]. Porous synthetic tapes (sling) have been globally used in such surgeries [8]; although this procedure has a high cure rate for SUI after 12 months, severe complications as erosion has been associated with the poor biocompatibility and inadequate biomechanical properties of polypropylene mesh-as lack of elasticity and high stiffness-when it is implanted into the pelvic floor [9,10]. Urinary retention has been a common postoperative complication [11,12].…”