Urethralysis for a Synthetic Periurethral Bulking Agent Collection, presented by the University of Illinois Department of Urology. The patient is a 63-year-old female with a history of hysterectomy and stress incontinence. She underwent sling placement, which failed. She then underwent a sling release. She was then treated with a periurethral durosphere injection, which not only failed, but also caused bladder spasms and sharp, throbbing pain. An MRI six months after her durosphere injection revealed an altered anatomy in the periurethral submucosal soft tissue. Translabial ultrasonography revealed a 1-centimeter spherical periurethral collection at the bladder neck. Cystoscopy revealed a spherical bulge in the proximal urethral wall, and retroflexion revealed a spherical bulge at the bladder neck. A weighted speculum was placed in the vagina, and a spherical collection was felt adjacent to the urethral wall at the bladder neck. The urethra was catheterized with a 16 French Foley catheter. The labia majora were then retracted laterally with stay sutures. A circumferential incision was made around the urethral meatus. Sharp and blunt dissection was then carried out to mobilize the urethra proximally, from the meatus to the bladder neck. The pubou urethralis muscle was then divided, and circumferential urethralysis was carried out proximally. The urethral pelvic ligament was also incised. Segments of previously excised mesh were identified and excised during the periurethral dissection. Urethralysis was carried out to the bladder neck, with care taken not to injure the urethral wall. A spherical 1-centimeter fluid collection was palpated to the left of the urethra, just distal to the bladder neck. The periurethral collection was dissected and unroofed, revealing an exudate. The exudate was sent for culture. As the collection was dissected further, it revealed a collection of durosphere with exudate exiting the sac. The sac was thoroughly examined, using the flexible cystoscope to search for any communications with the urethral lumen. However, no connections were found. Flexible cystoscopy was repeated, and revealed a resolution of the previously noted spherical bulge at the bladder neck. Following confirmatory cystoscopy, the periurethral collection sac was completely dissected and removed. The bladder neck and proximal urethra were then placated using a 1-centimeter fluid collection. The bladder neck and proximal urethra were then placated using a 1-centimeter fluid collection. The bladder neck and proximal urethra were then placated using a 1-centimeter fluid collection. The bladder neck and proximal urethra were then placated using a 1-centimeter fluid collection. The bladder neck and proximal urethra were then placated using 4-ovicryl interrupted sutures. The bladder neck and proximal urethra were then placated using a 1-centimeter fluid collection. The bladder neck and proximal urethra were then placated using a 1-centimeter fluid collection. The bladder neck and proximal urethra were then placated using a 1-centimeter fluid collection. The bladder neck and proximal urethra were then placated using a 1-centimeter fluid collection. The wound was copiously irrigated with an antibiotic solution, and the urethra was then wrapped with a strip of interseed mesh to guide the healing process. 4-ovicryl sutures were placed to stabilize the interseed mesh and to prevent its migration. 4-ovicryl sutures were placed to stabilize the interseed mesh and to prevent its migration. 4-ovicryl sutures were placed to stabilize the interseed mesh and to prevent its migration. Finally, the perimedial incision was closed in the same fashion. Finally, the perimedial incision was closed in the same fashion. The Foley catheter was removed 10 days following the procedure. The patient had improved symptoms. She is pain-free and has complete resolution of her incontinence. This concludes our presentation of urethralysis for a synthetic periurethral bulking agent collection.

Urethralysis

Synthetic Periurethral Bulking Agent Collection

University of Illinois Department of Urology

stress incontinence

surgical procedures