Transurethral intravesical mesh removal: Like a natural orifice laparoscopic single-site procedure (SIU 2011)
- uploaded: Jul 3, 2011
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Institution:Departments of Urology and Gynecology, Military Hospital Moulay Ismail, Meknes, Morocco
Objectives: we present our experience of an endoscopic removal of intravesical right lateral arms of a polypropylene mesh, placed for cystocele synthetic repair. The intravesical portion of the mesh was cut out using laparoscopic scissors.
Material and methods: A 54-year-old female was referred to our unit due to persistent mild hematuria. She has a cystocele synthetic repair, with a trans-obturator 4 arms polypropylene mesh, two weeks earlier. On examination, marked vaginal tenderness was noted; there was no infection and no urinary fistula. Diagnostic cystoscopy revealed intravesical mesh erosion, less than 1 cm right of the right ureteric orifice. Under spinal anesthesia in the lithotomy position, cystoscopy is performed using an 18 Fr nephroscope (without its 20.8 Fr outer sheath). A trans-urethral 5 mm laparoscopic shears is advance alongside the nephroscope, like a single site procedure. Both arms of the mesh are severed at the mesh junction. A strong bi-prong forceps is advanced through the working port of the nephroscope and both right trans-obturator arms are completely removed. Then, an 18 Fr Foley catheter is inserted.
Results: the transurethral total removal of the right arms of the polypropylene mesh was possible in 40 min. the Foley catheter was removed the 10th postoperative day. No complication was noted, especially, no vaginal fistula or infection. The patient is asymptomatic with no cystocele recurrence after a follow-up of 30 months.
Conclusion: caution should be exercised concerning cases with persisting lower urinary tract symptoms following mesh vaginal surgery, due to the possibility of the presence of an intravesical mesh. In such cases, the transurethral route can be easily performed and is less invasive, ensuring low morbidity.
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