Introduction & Objective :
Although the location of mesh to be found out is different, intravesically exposed mesh after midurethral sling procedures results from bladder erosion or missed intraoperative bladder perforation. It may results in considerable morbidity including stone formation and voiding difficulty and the mesh should be removed. We evaluated urinary functional outcomes according to the location of mesh.
Methods : Totally twenty six (26) patients had a transurethral removal(TUR) for intravesical mesh after midurethral sling surgery (tension free vaginal tape 15; transobturator tape 11). The mesh location was classified to urethral, vesical including neck and combined type. Patients were evaluated with physical examination, ultrasonography, stress test, bladder diary.
The mesh locations were as follows; urethral in 1 patient, vesical in 22 patients and combined type in 3 patients. The mesh was removed in all cases. Mean follow up was 34 months after the transurethral removal of mesh (range 12 to 60). On follow-up cystoscopic examination, a mesh remnant was observed in 4 patients. The remnant meshes were removed with repeat TUR. All patients had similar voiding patterns before TUR. But recurrence of incontinence after TUR of mesh was observed in 3 patients; 1 patient in combined type and 2 patients in vesical type. But the symptom was managed with only medications.
The recurrence and severity of incontinence are very low and mild. However, the majority of patients with recurred incontinence had bladder neck type. So TUR of mesh exposed on bladder neck needs carefulness not to injury neck function.
Samsung Changwon Hospital
Changwon, Kyongsang-namdo, Republic of Korea