Laparoscopic transvesical excision and reconstruction in the management of mid-urethral tape mesh erosion and stones around the bladder neck: initial experiences

Abstract

Study Type--Prevalence (prospective cohort) Level of Evidence 1b. What's known on the subject? and What does the study add? Managing foreign bodies, including mesh and stones, after anti-incontinence surgery is important because complete removal is necessary to prevent infection and recurrence of stone formation. Traditionally, surgical management of such complications has involved excision using a transurethral approach, with or without a laparoscopic transvesical procedure. The study shows that mesh complications, including exposure and adherent stones, can be successfully treated and a fast recovery can be achieved using transvesical laparoscopic excision and reconstruction. Transvesical laparoscopy is especially suitable for cases that have a restricted visual field with cystoscopy; the technique allows complete removal of mesh/stones and reconstruction with the help of an excellent visual field.

Objectives: • To evaluate laparoscopic transvesical excision and reconstruction for the management of vesical mesh or stones around the bladder neck as complications of anti-incontinence intervention. • To compare the techniques, outcomes and recurrence rates of laparoscopic transvesical excision and reconstruction with published results from studies using laparoscopic transvesical procedures.

Patients and methods: • We conducted a retrospective review of three patients who underwent laparoscopic transvesical excision and reconstruction for vesical mesh and stones around the bladder neck. • Patients were identified from operating records including recorded video and electronic data records. • We also conducted a literature review of the available evidence on transvesical laparoscopy for lower urinary tract complications of anti-incontinence procedures.

Results: • Between March 2005 and May 2011, three women underwent laparoscopic transvesical excision and reconstruction. All presented with storage symptoms and gross haematuria. The interval between surgery and the diagnosis of presence of a foreign body was 1-3 years. • Two women had previously undergone transobturator tape procedures and one had undergone a retropubic procedure. • Complete excision including the mucosa and muscle layer and reconstruction with intravesical sutures was achieved in all cases. • Storage symptoms were resolved within 3 days and haematuria was not observed. • None of the women had recurrent erosion at follow-up.

Conclusions: • Laparoscopic transvesical excision and reconstruction is a technically feasible method. • This procedure offers excellent visualization of mesh materials and stones, especially in cases of location near the anterior bladder neck. • In selected patients, laparoscopic transvesical excision and reconstruction is an acceptable technique for first-line treatment of complications of anti-incontinence procedures.