PFD Week 2016-Use of A Pediatric Nasal Speculum to Facilitate the Excision Of Urethral Mesh Erosion

Video Transcription

This video demonstrates a unique and efficient approach to transurethral mesh excision after urethral erosion.  While a rare complication, urethral mesh erosion can be difficult to manage. At our institution, we utilize a pediatric nasal speculum, a scissoscope, and scissoscopic  graspers and scissors. First the nasal speculum is gently inserted into the urethra, a methodical circumferential inspection is conducted.  Mesh fibers are grasped and carefully transected. An important thing to remember when doing the initial inspection is where within the  The use of the nasal speculum not only optimizes the visualization, but serves to guide the placement of scissoscopic instruments.  The speculum can be moved in a back and forth motion to reveal the perforated fibers which sometimes can be missed.  When resected, care is taken not to take large bites as this can compromise the mucosa and muscularis portions of the urethra.  We have utilized this technique on three individuals thus far. They currently report resolution of symptoms of urgency and frequency and are able to maintain continence.  In summary, the use of the nasal speculum optimizes visualization and avoids the need for a urethral incision which could further jeopardize urethral sphincter development.

Video Summary

This video showcases a unique and effective approach to managing urethral mesh erosion through transurethral mesh excision. The technique involves using a pediatric nasal speculum, a scissoscope, and scissoscopic graspers and scissors. By gently inserting the speculum into the urethra and conducting a thorough inspection, the mesh fibers are carefully transected. The speculum aids in visualizing and guiding the placement of the scissoscopic instruments, ensuring comprehensive removal of perforated fibers. Care is taken during resection to avoid compromising the urethra's mucosa and muscularis. This technique has been successfully employed on three patients, who have reported resolution of symptoms and maintained continence. The use of the nasal speculum eliminates the need for a urethral incision, preventing further complications with urethral sphincter development. (No credits were mentioned.)

Asset Subtitle

Leon Plowright, MD

Meta Tag

Category Surgery - Vaginal Procedures

Category Surgery - Novel Procedures

Category Complications

Keywords

urethral mesh erosion

transurethral mesh excision

pediatric nasal speculum

scissoscope

scissoscopic graspers and scissors