Advertisement

International Urogynecology Journal

, Volume 28, Issue 1, pp 155–156 | Cite as

Transvaginal sling excision: tips and tricks

  • Marisa M. CliftonEmail author
  • Howard B. Goldman
IUJ Video
  • 426 Downloads

Abstract

Introduction and hypothesis

Complications of synthetic midurethral sling surgery include bladder outlet obstruction, mesh extrusion, and vaginal pain. A treatment of these complications is transvaginal mesh removal. The objectives of this video are to present cases of complications after sling placement and describe techniques to help with successful sling removal.

Methods

Three patients are presented in this video. One experienced urinary hesitancy and was found to have bladder outlet obstruction on urodynamic study. The second patient presented to the clinic with diminished force of stream and significant dyspareunia. The last patient presented with mesh extrusion. After discussion of management options, all three patients wished to pursue transvaginal sling excision.

Results

All patients had successful removal of a portion of their synthetic midurethral sling. This video presents techniques to aide with dissection, mesh excision and prevention of further mesh complications. These include using an individualized surgical technique based on patient presentation and surgeon expertise, planning surgical incisions based on where mesh can be identified or palpated, using a cystoscope sheath or urethral dilator to identify any bladder outlet obstruction, and using a knife blade to identify mesh from surrounding tissue.

Conclusions

Sling excision can be successfully performed with careful surgical technique and dissection.

Keywords

Suburethral sling Urethra, surgical mesh Foreign-body migration Vaginal surgery 

Notes

Compliance with ethical standards

Conflicts of interest

None.

Support/Financial disclosures

Neither Dr Clifton nor Dr Goldman has any financial disclosures.

Consent

Written informed consent was obtained from the patient for publication of this video article and any accompanying images.

Supplementary material

ESM 1

(MP4 50962 kb)

References

  1. 1.
    Nager C, Tulikangas P, Milder D, Rovner E, Goldman HB. Position statement on mesh midurethral slings for stress urinary incontinence. Female Pelvic Med Reconstr Surg. 2014;20:123–5.CrossRefPubMedGoogle Scholar
  2. 2.
    Jonsson Funk M, Siddiqui NY, Pate V, Amundsen CL, Wu JM. Sling revision/removal for mesh erosion and urinary retention: long-term risk and predictors. Am J Obstet Gynecol. 2013;208:73.e1–7.CrossRefGoogle Scholar
  3. 3.
    Osborn DJ, Dmochowski RR, Harris CJ, et al. Analysis of patient and technical factors associated with midurethral sling mesh exposure and perforation. Int J Urol. 2014;11:1167–70.CrossRefGoogle Scholar
  4. 4.
    Brubaker L, Norton PA, Albo ME, et al. Adverse events over two years after retropubic or transobturator midurethral sling surgery: findings from the trial of midurethral slings (TOMUS) study. Am J Obstet Gynecol. 2011;205:498.e1–6.CrossRefGoogle Scholar
  5. 5.
    Abbott S, Unger CA, Evans JM, et al. Evaluation and management of complications from synthetic mesh after pelvic reconstructive surgery: a multicenter study. Am J Obstet Gynecol. 2014;210:163.e1–8.CrossRefGoogle Scholar
  6. 6.
    Welk B, Al-Hothi H, Winick-Ng J. Removal or revision of vaginal mesh used for the treatment of stress urinary incontinence. JAMA Surg. 2015;150:1167–75.CrossRefPubMedGoogle Scholar
  7. 7.
    Clifton MM, Linder BJ, Lightner DJ, Elliott DS. Risk of repeat anti-incontinence surgery following sling release: a review of 93 cases. J Urol. 2014;191:710–4.CrossRefPubMedGoogle Scholar

Copyright information

© The International Urogynecological Association 2016

Authors and Affiliations

  1. 1.Department of UrologyCleveland ClinicClevelandUSA

Personalised recommendations