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A Novel Combined Transurethral and Suprapubic Approach for Resection of Bladder Mesh
IUGA Academy. Ryu G. Jun 30, 2018; 213270
Topic: Stress Incontinence
Gloria Ryu
Gloria Ryu

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141

A novel combined transurethral and suprapubic approach for resection of bladder Mesh

Ryu, G1

1: Hospital Aarau

Introduction: A 68-year-old woman who presented with a 6-month history with irritative voiding symptoms and recurrent urinary tract infections was found to have persistent perforation into the bladder, of a tension-free vaginal tape placed 48 months before. The patient had undergone two previous mesh removals transurethrally at an outside institution. The patient continued to have recurrent urinary tract infections and was referred to our institution. Cystoscopy revealed stone formation and persistent mesh perforation.

Objective: To achieve radical excision, a novel combined transurethral and suprapubic approach was planned.

Methods: Following general anesthesia the patient was prepared in the dorsal lithotomy position. A cystoscope was inserted transuretherally and the bladder was filled with normal saline. Two suprapubic punctures were next carried out and 3.5-mm trocars were inserted into the bladder under direct cystoscopic vision. One surgeon used a 3.5 mm camera optics and a 3.5 mm grasper from the suprapubic side to pull on the stone and the perforated mesh, while the other surgeon used scissors transurethrally to resect the mesh and stone. At the end of the procedure, we left a Foley catheter with continuous lavation.

Results: The patient’s postoperative course was uneventful. At 1-month follow-up, the patient was asymptomatic and cystoscopy revealed partial healing of the mesh site. At 6-month follow-up, the patient continued to be asymptomatic and cystoscopy demonstrated complete healing of the mesh site. No further mesh erosion was present.

Conclusion: This combined transurethral and suprapubic maneuver allowed for adequate tension on the perforated mesh enabling to be removed adequately. Additionally the use of two cameras allowed for better visualization in locating the perforation and adequately removing it. The suprapubic camera adds additional spatial orientation and ease that leads to removal of the perforated mesh in its entirety at the challenging location of bladder neck and bladder base region. This novel technique provides an effective means of radically removing a mesh perforated into the bladder using a combined transurethral and suprapubic approach.

Disclosure:

Work supported by industry: no.

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