This case presents the work-up and management of a patient requesting surgical intervention for recurrent stress urinary incontinence after previous excision of a portion of her midurethral sling because of mesh exposure. Four international experts provide their approach to this complex case. There is little consensus regarding further surgery in a patient who has required mesh excision. Treatment by fascial sling was commonly considered and the literature review outlines the pros and cons of autologous fascia versus donor fascia for this specific case.
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Conflicts of interest
E.A. Brennand: grant in-aid funding, for an investigator-initiated randomized clinical trial from Boston Scientific (ClinicalTrials.gov, identifier: NCT02480231); C.L. Grimes: expert witness, Johnson and Johnson; H.W. Brown: receives royalties from Wolters-Kluwer (UpToDate, Inc.) and serves as a consultant for Grand Rounds, Inc.; F.G. Ugurlucan, S. Jeffery, P. Campbell, L.A. Yurteri-Kaplan: no relevant conflicts of interest.
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Brennand, E.A., Ugurlucan, F.G., Brown, H.W. et al. Female Pelvic Medicine and Reconstructive Surgery challenges on behalf of the Collaborative Research in Pelvic Surgery Consortium: managing complicated cases. Int Urogynecol J (2020). https://doi.org/10.1007/s00192-020-04385-3
- Mesh exposure
- Midurethral sling
- Recurrent stress urinary incontinence