Korean J Urol.  2010 Jun;51(6):416-419.

Vaginal Mucosal Flap as a Sling Preservation for the Treatment of Vaginal Exposure of Mesh

• Kim SY
• Park JY
• Kim HK
• Park CH
• Kim SJ
• Sung GT
• Park CM

Abstract

PURPOSE
Tension-free vaginal tape (TVT) procedures are used for the treatment of stress urinary incontinence in women. The procedures with synthetic materials can have a risk of vaginal erosion. We experienced transobturator suburethral sling (TOT) tape-induced vaginal erosion and report the efficacy of a vaginal mucosal covering technique.
MATERIALS AND METHODS
A total of 560 female patients diagnosed with stress urinary incontinence underwent TOT procedures at our hospital between January 2005 and August 2009. All patients succeeded in follow-ups, among which 8 patients (mean age: 50.5 years) presented with vaginal exposure of the mesh. A vaginal mucosal covering technique was performed under local anesthesia after administration of antibiotics and vaginal wound dressings for 3-4 days.
RESULTS
Seven of the 8 patients complained of persistent vaginal discharge postoperatively. Two of the 8 patients complained of dyspareunia of their male partners. The one remaining patient was otherwise asymptomatic, but mesh erosion was discovered at the routine follow-up visit. Six of the 8 patients showed complete mucosal covering of the mesh after the operation (mean follow-up period: 16 moths). Vaginal mucosal erosion recurred in 2 patients, and the mesh was then partially removed. One patient had recurrent stress urinary incontinence.
CONCLUSIONS
Vaginal mucosal covering as a sling preservation with continued patient continence may be a feasible and effective option for the treatment of vaginal exposure of mesh after TOT tape procedures.

Keyword

Complications; Suburethral slings; Surgical mesh

MeSH Terms

Anesthesia, Local
Anti-Bacterial Agents
Bandages
Dyspareunia
Female
Follow-Up Studies
Humans
Male
Suburethral Slings
Surgical Mesh
Urinary Incontinence
Vaginal Discharge
Anti-Bacterial Agents

Figure

• 

  FIG. 1 Local anesthesia on the mucosa surrounding the eroded tape with 2% lidocaine and the designed mucosal flap around the exposed mesh (see black line).

• 

  FIG. 2 Granuloma around the tape and undermining of the submucosal layer, which was performed until there was no tension on the mucosal flap. The tape was covered with the vaginal wall mucosal advancement flap and sutured tightly with 4-0 chromic gut sutures.

Reference

1. Ulmsten U, Henriksson L, Johnson P, Varhos G. An ambulatory surgical procedure under local anesthesia for treatment of female urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct. 1996; 7:81–85. PMID: 8798092.

2. Delorme E. Transobtuator urethral suspension: mini-invasive procedure in the treatment of stress urinary incontinence in women. Prog Urol. 2001; 11:1306–1313. PMID: 11859672.

3. Kim TH, Seo JT. Comparison of the efficacy and vaginal erosion rate between monofilament and multifilament polypropylene tapes for treating urinary incontinence. Korean J Urol. 2008; 49:844–849.

4. Karram MM, Segal JL, Vassallo BJ, Kleeman SD. Complications and untoward effects of the tension-free vaginal tape procedure. Obstet Gynecol. 2003; 101:929–932. PMID: 12738152.

5. Bafghi A, Benizri EI, Trastour CT, Benizri EJ, Michiels JF, Bongain A. Multifilament polypropylene mesh for urinary incontinence: 10 cases of infections requiring removal of the sling. BJOG. 2004; 112:376–378. PMID: 15713159.

6. Domingo S, Alama P, Ruiz N, Perales A, Pellicer A. Diagnosis, management and prognosis of vaginal erosion after transobturator suburethral tape procedure using a nonwoven thermally bonded polypropylene mesh. J Urol. 2005; 173:1627–1630. PMID: 15821518.

7. Bhargava S, Chapple CR. Rising awareness of the complications of synthetic slings. Curr Opin Urol. 2004; 14:317–321. PMID: 15626872.

8. Deval B, Haab F. Management of the complications of the synthetic slings. Curr Opin Urol. 2006; 16:240–243. PMID: 16770121.

9. Kobashi KC, Govier FE. Management of vaginal erosion of polypropylene mesh slings. J Urol. 2003; 169:2242–2243. PMID: 12771759.

10. Al-Wadi K, Al-Badr A. Martius graft for the management of tension-free vaginal tape vaginal erosion. Obstet Gynecol. 2009; 114:489–491. PMID: 19622973.

11. Domingo S, Alama P, Ruiz N, Perales A, Pellicer A. Diagnosis, management and prognosis of vaginal erosion after transobturator suburethral tape procedure using a nonwoven thermally bonded polypropylene mesh. J Urol. 2005; 173:1627–1630. PMID: 15821518.

12. Lee T, Kim JS, Jung JK, Lee HJ. Surgical management of vaginal wound healing defects after tension-free vaginal tape placement. Int J Urol. 2005; 12:699–701. PMID: 16045568.