Urethral erosion after suburethral synthetic slings: risk factors, diagnosis, and functional outcome after surgical management

Abstract

Urethral erosion (UE) is an uncommon but potentially severe complication after suburethral synthetic slings. We aimed to identify the risk factors and diagnostic modalities of UE and also functional outcome after UE surgical management. We retrospectively analyzed eight cases of UE managed in our department between 1997 and 2007. The main presumptive risk factors of UE were excessive sling tensioning (six of eight) and postoperative urethral dilation (four of eight). The most frequent symptoms included voiding difficulties (five of eight), storage symptoms (three of eight), pain (three of eight), and recurrent stress incontinence (three of eight). UE diagnosis was accessible to introital ultrasound (five of five) and confirmed by urethroscopy (eight of eight). Surgical management was performed in seven cases and included transvaginal sling removal with urethral repair (two of seven), endoscopic transurethral sling resection (four of seven), and combined approach (one of seven). All the approaches provided good functional outcomes. Transurethral endoscopy is a mini-invasive treatment of UE and should be tried first in selected cases.

Evaluation of Endoscopic Laser Excision of Polypropylene Mesh/Sutures Following Anti-Incontinence Procedures

“…These findings are consistent with other studies that describe macro-/microscopic haematuria and recurrent UTIs as predominant symptoms in erosive complications (9,(12)(13). Other common presenting symptoms are suprapubic discomfort, recurrent SUI, de novo frequency and de novo urgency.…”

Transurethral holmium laser intravesical tape excision following TVT procedure: results from seven patients in a 12-month follow-up

“…The tape acts as a foreign body intravesically, so it is easily inhabited by microbes leading to abnormal urine analysis values [25]. Transabdominal ultrasound examination of the bladder may assist in the diagnosis of a large intravesically protruding calcified mesh, but perineal ultrasonography (2D/3D) seems to be more effective [26]. Nevertheless, ultrasound examination advantages are the measurement of PVR (higher PVR in patients with incorrectly placed tapes) and in the assessment of the patency of the pelvicocalyceal system, excluding the potential damage to the lower ureters [27].…”

A Giant Female Urethral Stone: An Unusual Complication after MidUrethral Sling Operation

“…Patients are admitted to hospitals with recurrent UTI and nonspecific complaints such as overactive bladder symptoms, urethral or pelvic pain, recurrent stress incontinence, urinary retention, dyspareunia and hematuria. Patient-related factors are vaginal atrophy, scarring and post-radiation and intraoperative urethral injury, and iatrogenic causes are deep dissection made in a wrong plane toward urethral mucosa, not obeying the tension-free rule while placing the mesh, friction or migration of mesh and urethral dilatation to relieve postoperative bladder outlet obstruction [8] .…”