Korean J Urol.  2011 Dec;52(12):829-834.

Outcomes of Transurethral Removal of Intravesical or Intraurethral Mesh Following Midurethral Sling Surgery

• Jo DJ
• Lee YS
• Oh TH
• Ryu DS
• Kwak KW

Abstract

PURPOSE
To present outcomes of transurethral removal (TUR) of intravesical or intraurethral mesh after midurethral slings.
MATERIALS AND METHODS
This was a retrospective chart review of 23 consecutive women: 20 with intravesical mesh and 3 with intraurethral mesh.
RESULTS
To remove the mesh, transurethral resection with an electrode loop (TUR-E) was used in 16 women and transurethral resection with a holmium laser (TUR-H) was used in 7. The median follow-up was 2.1 months. Twenty-six percent of the women (6/23) had a mesh remnant: 6.2% (1/16) of the women treated with TUR-E and 71.4% (5/7) of the women treated with TUR-H. Of the 5 women treated with TUR-H, 3 underwent concomitant transvaginal removal. On the follow-up cystoscopic exam, a mesh remnant was observed in 3 women (1 treated with TUR-E and 2 treated with TUR-H). Vesico-vaginal fistulas were found in 2 women during and after TUR-E, respectively. Stress urinary incontinence recurred in 1 woman.
CONCLUSIONS
TUR-E has a high success rate but carries a risk of bladder perforation. Complete resection using TUR-H depends on the location of the mesh and the range of motion of the instrument.

Keyword

Complications; Management; Suburethral slings

MeSH Terms

Electrodes
Female
Fistula
Follow-Up Studies
Humans
Lasers, Solid-State
Range of Motion, Articular
Retrospective Studies
Suburethral Slings
Urinary Bladder
Urinary Incontinence

Figure

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  FIG. 1 Pictures of the transurethral resection with an electrode loop for intravesical mesh. (A) Preoperative finding: stone encrustation. (B) Postoperative finding: no mesh remained and perivesical fat was seen.

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  FIG. 2 Pictures of the transurethral resection with a holmium laser for intravesical mesh. (A) Preoperative finding: stone encrustation. (B) Postoperative finding: no mesh remained.

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  FIG. 3 Pictures of the combined transvaginal and transurethral resection with a holmium laser for intraurethral mesh. (A) Preoperative finding: stone encrustation. (B) Postoperative finding: no mesh remained after transvaginal removal.

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