A novel combined transurethral and suprapubic approach for excision of mesh at the bladder neck

Autor: Tilmann Moeltgen, Zaraq Khan, Dimitri Sarlos, Gloria Ryu, Heimo Magg, Gabriel N. Schaer
Rok vydání: 2019
Předmět:
Zdroj: International Urogynecology Journal. 31:663-665
ISSN: 1433-3023
0937-3462
DOI: 10.1007/s00192-019-04110-9
Popis: Unrecognized bladder perforation of a tension-free sling is a rare situation. Removal of the intravesical sling has been done by laparotomy or transurethrally. With technique presented here we want to show a minimally invasive approach that allows complete removal of the intraluminal sling material, located at the bladder neck. This video shows a novel combined transurethral and suprapubic approach for radical removal of the mesh. Two 3.5-mm trocars were placed suprapubically into a filled bladder. One site was used for an optic with camera and the other for a 3.5-mm grasping forceps to apply tension on the mesh to pull it out of the bladder wall while it was being excised transurethrally with a cystoscope and transurethral scissors. The patient’s postoperative course was uneventful. At 1-month follow-up, the patient was free of dysuria and cystoscopy revealed complete healing of the mesh site. Because of recurrent stress urinary incontinence, another continence sling surgery has been performed (TVT exact). After a follow-up of 2 years, she is continent and free of dysuria. This novel technique provides an effective means of removing mesh perforated into the bladder, located at the bladder neck, using a combined transurethral and suprapubic approach. The technique is minimally invasive and the applied traction allows complete removal of the intraluminal part of the mesh.
Databáze: OpenAIRE
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