V2-08: A New Limited Open Technique for Complete Removal of Retropubic Synthetic Midurethral Sling Mesh
While synthetic midurethral sling placement is generally a safe and effective treatment for female stress urinary incontinence, a small percentage of patients will require sling excision for post-operative complications including urinary obstruction, mesh exposure, or pain. Though many of these complications can be addressed with suburethral or local sling excision, refractory chronic pain may require total mesh excision._x000D_ _x000D_ One of the greatest concerns for surgeons performing total mesh excision of a retropubic sling is the potential morbidity of the operation, including wound complications associated with extensive retropubic dissection to localize the sling arms. With these concerns in mind, we present a technique for total retropubic sling excision which limits the extent of retropubic dissection._x000D_
A 48 year old female patient underwent retropubic synthetic sling placement in 2010, followed by vaginal, urethral, and suprapubic pain, as well stranguria, incomplete emptying and persistent urgency, frequency and urgency incontinence. After preoperative evaluation, in light of her chronic suprapubic pain, she was offered total retropubic sling excision. She elected to proceed after discussion of risks, benefits, and alternatives. _x000D_ _x000D_ The novelty of our procedure is seen in the limited retropubic dissection. Each arm of the sling mesh is mobilized vaginally to the level of the endopelvic fascia. The retropubic space is entered via a vaginal approach and developed bluntly. Only then is abdominal exposure sought; at this point, gentle traction on the sling arm can be seen from above, allowing for only a tiny fascial incision to be made directly over the sling arm location. The retropubic portion of the mesh is then traced to the vaginal portion, and the sling arm is freed in its entirety. This is repeated on the contralateral side._x000D_
At four week follow up, the patient reported greater than 90% improvement in her pain, with improved ease of voiding. She had no wound complications.
Our novel technique allows for complete retropubic sling mesh removal with limited retropubic dissection, which may minimize the surgical morbidity and decrease the risk of wound complications.