Research Information System
2. Uluslararası Jinokoloji ve Obstetri Kongresi, Muğla, Turkey, 3 - 06 November 2022, pp.115-116
Introduction
Transobturator tape surgery is an effective surgical approach for stress urinary incontinence. Mesh erosion is a common complication of the approach with the rates reaching up to 5%.(1,2) Although most of the erosions are seen on vagina, bladder could be effected.(3)
Case
A 51 year old lady with one previous vaginal birth presented to our urogynecology outpatient clinic with occasional dysuria, frequent urinary tract infections and chronic pelvic pain.At her examination, a suspicious area resembling mesh erosion at the base of the bladder was identified at the transvaginal ultrasound. She has undergone a total abdominal hysterectomy with bilateral salpingectomy in 2010 for abnormal uterine bleeding and a previous transobturator tape (TOT) and cystocele repair surgery in 2019 in another hospital. After the TOT operation, two diagnostic cystoscopy and two operative cystoscopy procedures was performed for her symptoms in previous 2 years in different medical centers and mesh erosion was detected. A diagnostic cystoscopy, bilateral mono j stent placement and laparoscopic excision of the eroded mesh with cystotomy was performed without any peri-operative complication in November 2021.
At the cystoscopy eroded areas were identified and bilateral mono j stents were placed. At the laparoscopy prevesical and paravesical spaces were dissected and cystotomy was performed with cold knife.Eroded areas which were at the dome of the bladder were excised with partial cystectomy. Eroded mesh at the base of the bladder was excised from the surrounding bladder mucosa. Bladder mucosa was sutured with 3.0 rapid vicryl continuosly. Muscular and serosal layer were sutured with 2.0 vicryl.
Mono j catheters were taken out at the post-operative 3rd day and her abdominal drain was taken out at the post-operative 4th day.She was discharged from the hospital without any complications with oral antibiotics at the 5th day. At the 1st and 6th months after the surgery, her symptoms were reduced significantly and she has not had any urinary tract infection after the operation.
Discussion
Mesh erosion is a relatively common complication seen after TOT surgery. Partial cystectomy with resection of the mesh with healty bladder tissue margin is an effective procedure to alleviate patient symptoms.