Nitya Abraham1, Adrienne Quirouet, Sandip Vasavada. 1. Department of Female Pelvic Medicine and Reconstructive Surgery, Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Ave, Q10-1, Cleveland, OH, 44195, USA, nitya.abraham@gmail.com.
Abstract
INTRODUCTION AND HYPOTHESIS: Urethral complications due to synthetic midurethral slings are rare. Possible causes may include unrecognized trocar injury, mesh implantation despite recognized injury, mesh contamination leading to inflammation and delayed perforation, and excessive sling tension. There is no consensus as to the surgical management of urethral complications with regard to how much mesh should be excised, whether an interposition flap should be used, and whether a pubovaginal sling should be placed at the time of surgery. The purpose of this video is to present a technique of repairing complete urethral disruption due to a synthetic midurethral sling complication. METHODS: In this video, we demonstrate the steps to perform primary end-to-end urethral reconstruction for repairing complete urethral disruption. Any residual synthetic mesh must first be excised, after which the anastomosis may be completed. RESULTS: Complete urethral disruption is a rare complication of synthetic midurethral sling surgery that can be repaired primarily with good results. CONCLUSIONS: There is no consensus regarding surgical management of urethral complications caused by synthetic midurethral slings, and thus an individualized approach should be used based on patient presentation and surgeon expertise.
INTRODUCTION AND HYPOTHESIS: Urethral complications due to synthetic midurethral slings are rare. Possible causes may include unrecognized trocar injury, mesh implantation despite recognized injury, mesh contamination leading to inflammation and delayed perforation, and excessive sling tension. There is no consensus as to the surgical management of urethral complications with regard to how much mesh should be excised, whether an interposition flap should be used, and whether a pubovaginal sling should be placed at the time of surgery. The purpose of this video is to present a technique of repairing complete urethral disruption due to a synthetic midurethral sling complication. METHODS: In this video, we demonstrate the steps to perform primary end-to-end urethral reconstruction for repairing complete urethral disruption. Any residual synthetic mesh must first be excised, after which the anastomosis may be completed. RESULTS: Complete urethral disruption is a rare complication of synthetic midurethral sling surgery that can be repaired primarily with good results. CONCLUSIONS: There is no consensus regarding surgical management of urethral complications caused by synthetic midurethral slings, and thus an individualized approach should be used based on patient presentation and surgeon expertise.
Authors: Linda Brubaker; Peggy A Norton; Michael E Albo; Toby C Chai; Kimberly J Dandreo; Keith L Lloyd; Jerry L Lowder; Larry T Sirls; Gary E Lemack; Amy M Arisco; Yan Xu; John W Kusek Journal: Am J Obstet Gynecol Date: 2011-07-20 Impact factor: 8.661