PFD Week 2016-A Novel Technique for Transurethral Excision of Intravesical Synthetic Mesh Extrusion

Video Transcription

A 55-year-old woman with a post hysterectomy pelvic organ prolapse and urinary incontinence underwent reconstructive pelvic surgery with utilization of anterior and posterior avalto  mesh kit and LYNX TVT system. During this surgery, she developed urinary urgency, frequency, suprafugic pain, and recurrent urinary tract infections.  She subsequently underwent placement of a sacral neurostimulator for presumed refractory overactive bladder. Nocestoscopy were performed after index surgery.  She presented four years later to our urogynecology clinic for second opinion. The stethoscopy revealed two centimeters mesh erosion on the posterior bladder wall near  the right ureteral orifice.  We utilized a vicral endoloop device for intravasical mesh removal. The endoloop suture was introduced into the bladder adjacent to the stethoscope.  The suture was passed under the bend of the mesh.  The distal loop of the suture gripped with the graspers.  The suture was brought out of the urethra and clamped for traction.  Five millimeter endoscopic scissors were introduced through the working channel of the stethoscope to cut the left insertion of the mesh into the mucosa.  The left side of the mesh was successfully cut.  The right side of the mesh was grasped with the grasper and the scissors were introduced through the second stethoscopic channel and the right side of the mesh was cut.  The second endoloop suture was introduced into the bladder and secured around the remaining portion of the mesh.  The scissors were used to excise the mesh at the right exit site.  It was removed, secured in the endoloop suture. The endoscopic scissors were reintroduced to trim remaining mesh fibers until no visible fibers were seen.  At the end of operative stethoscopy, detailed inspection of the bladder revealed intact bladder uricillium. Both urethral orifices were patent and a fluxing indicocarmine.  The endoscopic scissors were used to excise the mesh at the right exit site and the urethral orifice.  The endoscopic scissors were used to excise the mesh at the right exit site and the urethral orifice.  The endoscopic scissors were used to excise the mesh at the right exit site and the urethral orifice.  The endoscopic scissors were used to excise the mesh at the right exit site and the urethral orifice.

Video Summary

A 55-year-old woman underwent reconstructive pelvic surgery for pelvic organ prolapse and urinary incontinence. She developed urinary urgency, frequency, pain, and recurrent infections. She later had a sacral neurostimulator implanted for overactive bladder. Four years later, a second opinion revealed mesh erosion on the posterior bladder wall. Intravasical mesh removal was performed using an endoloop device. The remaining mesh was excised, and the bladder was inspected and found to be intact. The mesh at the right exit site and the urethral orifice were also excised.

Asset Subtitle

Raisa Platte, MD

Meta Tag

Category Surgery - Vaginal Procedures

Category Complications

Category Urinary Incontinence

Keywords

reconstructive pelvic surgery

pelvic organ prolapse

urinary incontinence

sacral neurostimulator

mesh erosion