Vaginal Mucosal Flap as a Sling Preservation for the Treatment of Vaginal Exposure of Mesh

Abstract

PurposeTension-free vaginal tape (TVT) procedures are used for the treatment of stress urinary incontinence in women. The procedures with synthetic materials can have a risk of vaginal erosion. We experienced transobturator suburethral sling (TOT) tape-induced vaginal erosion and report the efficacy of a vaginal mucosal covering technique.Materials and MethodsA total of 560 female patients diagnosed with stress urinary incontinence underwent TOT procedures at our hospital between January 2005 and August 2009. All patients succeeded in follow-ups, among which 8 patients (mean age: 50.5 years) presented with vaginal exposure of the mesh. A vaginal mucosal covering technique was performed under local anesthesia after administration of antibiotics and vaginal wound dressings for 3-4 days.ResultsSeven of the 8 patients complained of persistent vaginal discharge postoperatively. Two of the 8 patients complained of dyspareunia of their male partners. The one remaining patient was otherwise asymptomatic, but mesh erosion was discovered at the routine follow-up visit. Six of the 8 patients showed complete mucosal covering of the mesh after the operation (mean follow-up period: 16 moths). Vaginal mucosal erosion recurred in 2 patients, and the mesh was then partially removed. One patient had recurrent stress urinary incontinence.ConclusionsVaginal mucosal covering as a sling preservation with continued patient continence may be a feasible and effective option for the treatment of vaginal exposure of mesh after TOT tape procedures.

Tratamiento reconstructivo de la estenosis uretral femenina secundaria a erosión por cinta suburetral

“…No se registró complicación alguna relacionada con la reparación. La estancia media hospitalaria fue 2,3 (1-5) días y el tiempo de mantenimiento postoperatorio del catéter (22 Ch) de 12,3 (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) días. Las pacientes fueron evaluadas tras la cirugía con un seguimiento medio de 34,3 (12-55) meses, encontrándose sin incontinencia, sin síntomas obstructivos y con resultados cosméticos y funcionales (residuo, flujo máximo) satisfactorios (tabla 1).…”

“…Los síntomas que produce la erosión mucosa de la vagina, cuya incidencia parece similar para TOT y TVT, incluyen el flujo vaginal, el sangrado vaginal, la dispareunia y la infección urinaria recurrente 8 . Esta complicación generalmente se trata con recorte parcial de la malla expuesta y resutura vaginal, refrescando el borde del epitelio vaginal y movilizando un colgajo de mucosa vaginal para cubrir de nuevo la cinta, sin retirarla.…”

“…Esta complicación generalmente se trata con recorte parcial de la malla expuesta y resutura vaginal, refrescando el borde del epitelio vaginal y movilizando un colgajo de mucosa vaginal para cubrir de nuevo la cinta, sin retirarla. La ansiedad que genera la posible recurrencia de la incontinencia y la esperable mejora en la vida sexual con este abordaje son los principales pilares que soportan este tratamiento conservador 8,9 . No obstante, en los pacientes en los que este abordaje no resuelve su condición debe plantearse la excisión de la malla 9,10 .…”

Mid‐urethral sling revision for mesh exposure–long‐term outcomes of two surgical techniques from a comparative clinical retrospective cohort study

“…Various strategies have been described in the literature for the management of symptomatic sling exposures. These include revision of the sling by complete vaginal excision of the sling up to lateral pubic rami and vaginal closure, or sling conservation with freshening the edges of the vagina around the exposure with simple closure or using a full‐thickness autologous vaginal epithelium graft …”

Urethral Erosion and Perineal Cellulitis after Midurethral Sling Procedure

“…Novara et al [ 6 ] reported that the incidence of vaginal erosion was 0.4 to 3.8% following TVT surgery according to a review of literatures which have been published during the 2000's. In Korea, Kim et al [ 7 ] have recently reported that the incidence of vaginal erosion following a sling procedure was 1.4%.…”