Urogenit Tract Infect.  2019 Aug;14(2):60-63. 10.14777/uti.2019.14.2.60.

Recurrent Urinary Tract Infection from Urethral Mesh Erosion after Midurethral Mesh Sling Surgery

• Han JY

• KMID: 2456611
• DOI: http://doi.org/10.14777/uti.2019.14.2.60

Abstract

This paper presents three cases of recurrent urinary tract infections from urethral mesh erosion after transobturator midurethral sling (MUS) surgery. The patients were operated on using a MUS with a mesh for stress urinary incontinence. A few years after surgery (0.3 to 7 years), patients complained of recurrent pain in the urethra with voiding symptoms. In all cases, urethrocystoscopy was performed and an erosion of the sling directly across the urethra was found. Patients were managed by dissecting the urethra and removing the mesh via the transvaginal approach under general anesthesia.

Keyword

Urinary tract infections; Surgical mesh; Urethra; Stress urinary incontinence

MeSH Terms

Anesthesia, General
Animals
Humans
Mice
Suburethral Slings
Surgical Mesh
Urethra
Urinary Incontinence
Urinary Tract Infections*
Urinary Tract*

Figure

• 

  Fig. 1 Mesh erosion in the urethra on urethrocystoscope.

Reference

1. Ford AA, Rogerson L, Cody JD, Aluko P, Ogah JA. Mid-urethral sling operations for stress urinary incontinence in women. Cochrane Database Syst Rev. 2017; 7:CD006375.

2. Serati M, Braga A, Athanasiou S, Tommaselli GA, Caccia G, Torella M, et al. Tension-free vaginal tape-obturator for treatment of pure urodynamic stress urinary incontinence: efficacy and adverse effects at 10-year follow-up. Eur Urol. 2017; 71:674–679.

3. Ulrich D, Tammaa A, Holbfer S, Trutnovsky G, Bjelic-Radisic V, Tamussino K, et al. Ten-year followup after tension-free vaginal tape-obturator procedure for stress urinary incontinence. J Urol. 2016; 196:1201–1206.

4. Richter HE, Albo ME, Zyczynski HM, Kenton K, Norton PA, Sirls LT, et al. ; Urinary Incontinence Treatment Network. Retropubic versus transobturator midurethral slings for stress incontinence. N Engl J Med. 2010; 362:2066–2076.

5. Cadish LA, West EH, Sisto J, Longoria T, Bebchuk JD, Whitcomb EL. Preoperative vaginal estrogen and midurethral sling exposure: a retrospective cohort study. Int Urogynecol J. 2016; 27:413–417.

6. Masata J, Svabik K, Zvara K, Drahoradova P, El Haddad R, Hubka P, et al. Randomized trial of a comparison of the efficacy of TVT-O and single-incision tape TVT SECUR systems in the treatment of stress urinary incontinent women--2-year follow-up. Int Urogynecol J. 2012; 23:1403–1412.

7. Brubaker L, Norton PA, Albo ME, Chai TC, Dandreo KJ, Lloyd KL, et al. Urinary Incontinence Treatment Network. Adverse events over two years after retropubic or transobturator midurethral sling surgery: findings from the Trial of Midurethral Slings (TOMUS) study. Am J Obstet Gynecol. 2011; 205:498.e1–498.e6.

8. Sergouniotis F, Jarlshammar B, Larsson PG. Urethral complications after tension-free vaginal tape procedures: a surgical management case series. World J Nephrol. 2015; 4:396–405.

9. Morton HC, Hilton P. Urethral injury associated with minimally invasive mid-urethral sling procedures for the treatment of stress urinary incontinence: a case series and systematic literature search. BJOG. 2009; 116:1120–1126.

10. Sweat SD, Itano NB, Clemens JQ, Bushman W, Gruenenfelder J, McGuire EJ, et al. Polypropylene mesh tape for stress urinary incontinence: complications of urethral erosion and outlet obstruction. J Urol. 2002; 168:144–146.

11. Brophy MM, Klutke JJ, Klutke CG. A review of the tension-free vaginal tape procedure: outcomes, complications, and theories. Curr Urol Rep. 2001; 2:364–369.

12. Clemens JQ, DeLancey JO, Faerber GJ, Westney OL, Mcguire EJ. Urinary tract erosions after synthetic pubovaginal slings: diagnosis and management strategy. Urology. 2000; 56:589–594.

13. Petri E, Ashok K. Complications of synthetic slings used in female stress urinary incontinence and applicability of the new IUGA-ICS classification. Eur J Obstet Gynecol Reprod Biol. 2012; 165:347–351.

14. Daneshgari F, Kong W, Swartz M. Complications of mid urethral slings: important outcomes for future clinical trials. J Urol. 2008; 180:1890–1897.

15. Siegel AL. Urethral necrosis and proximal urethro-vaginal fistula resulting from tension-free vaginal tape. Int Urogynecol J Pelvic Floor Dysfunct. 2006; 17:661–664.

16. Minaglia S, Oyama IA. Urethral mesh erosion after single-incision mid-urethral sling. Female Pelvic Med Reconstr Surg. 2012; 18:310–312.

17. Groutz A, Levin I, Gold R, Pauzner D, Lessing JB, Gordon D. “Inside-out” transobturator tension-free vaginal tape for management of occult stress urinary incontinence in women undergoing pelvic organ prolapse repair. Urology. 2010; 76:1358–1361.

18. Nygaard I, Brubaker L, Chai TC, Markland AD, Menefee SA, Sirls L, et al. Risk factors for urinary tract infection following incontinence surgery. Int Urogynecol J. 2011; 22:1255–1265.

19. MacDonald S, Terlecki R, Costantini E, Badlani G. Complications of transvaginal mesh for pelvic organ prolapse and stress urinary incontinence: tips for prevention, recognition, and management. Eur Urol Focus. 2016; 2:260–267.

20. Chermansky CJ, Winters JC. Complications of vaginal mesh surgery. Curr Opin Urol. 2012; 22:287–291.

21. Viragh KA, Cohen SA, Raz S, Lo J, Raman SS. Translabial ultrasound in midurethral sling (mesh) visualization and erosion detection in women with stress urinary incontinence: a retrospective pilot study. Ultrasound Q. 2018; 34:238–244.

22. Wang C, Zimmern PE, Lemack G. Long-term results of transurethral endoscopic excision using the Holmium laser for urethral perforation of synthetic slings. Low Urin Tract Symptoms. 2019; 11:O103–O110.

23. Khanuengkitkong S, Lo TS, Dass AK. Delayed vaginal and urethral mesh exposure: 10 years after TVT surgery. Int Urogynecol J. 2013; 24:519–521.

24. Dwyer PL, Riss P. The mesh debate. Int Urogynecol J. 2012; 23:1–2.

25. Lee D, Zimmern PE. Management of complications of mesh surgery. Curr Opin Urol. 2015; 25:284–291.