V2-01: Transvaginal Sling Excision: Tips and Tricks
Synthetic midurethral sling placement is the most common procedure performed for women with symptomatic stress urinary incontinence. Postoperative complications are well documented in the literature. The estimated rate of sling revision for urethral obstruction is approximately 2.3% and for mesh extrusion is 1.8%. However, this may be an underestimate of the true incidence. Herein, we present three separate cases of mesh excision and provide tips to improve surgical outcomes in these patients_x000D_
Three separate cases of mesh excision were recorded. Techniques utilized in sling excision were discussed in this video
Our first patient underwent transobturator sling in 2010 for symptomatic stress incontinence. Postoperatively, she developed voiding dysfunction and was evaluated for urinary hesitancy and weak stream. Her office cystoscopy was negative for mesh perforation and urodynamic study showed evidence of outlet obstruction. She elected to proceed with excision of a portion of the sling._x000D_ _x000D_ Our second case is of a patient who underwent a sling for mixed urinary incontinence. Postoperatively, her urgency incontinence worsened significantly and she complained of significant dyspareunia. Her physical examination demonstrated pain where her sling was palpable at the midurethra. Cystoscopy was negative for mesh perforation, however, urodynamics showed evidence of bladder outlet obstruction. _x000D_ _x000D_ Our third patient underwent sling placement for stress incontinence in 2006. Approximately 2 months before presentation, her husband felt mesh during sexual intercourse. During physical examination, mesh was palpable at the right sulcus. The patient wished to have this portion of the sling removed.
In summary, plan incisions based on where mesh can be identified. If the location of the obstructing mesh is not apparent, use a cystoscope sheath or dilator to help with identification. If it is difficult to identify mesh during the dissection, a knife may help identify mesh from surrounding tissues. When performing sling excision for extrusion, ensure an adequate length of mesh is removed to prevent recurrence.