Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Jan;31(1):45-53.
doi: 10.1007/s00192-019-04087-5. Epub 2019 Aug 29.

Role of endoscopic management in synthetic sling/mesh erosion following previous incontinence surgery: a systematic review from European Association of Urologists Young Academic Urologists (YAU) and Uro-technology (ESUT) groups

Sulaiman Sadaf Karim  1 , Amelia Pietropaolo  1 , Andreas Skolarikos  2 , Omar Aboumarzouk  3 , Panagiotis Kallidonis  4 , Thomas Tailly  5 , Vincent de Coninck  6 , Etienne Xavier Keller  7 , Bhaskar Kumar Somani  8   9
Affiliations

Role of endoscopic management in synthetic sling/mesh erosion following previous incontinence surgery: a systematic review from European Association of Urologists Young Academic Urologists (YAU) and Uro-technology (ESUT) groups

Sulaiman Sadaf Karim et al. Int Urogynecol J. 2020 Jan.

Abstract

Introduction and hypothesis: Foreign body (FB) erosion is now recognized as a major long-term complication following previous incontinence surgery. The aim of our systematic review was to ascertain the outcomes of endoscopic management in synthetic sling/mesh erosion following previous gynaecological surgery.

Methods: A systematic review in line with PRISMA and Cochrane guidelines was conducted for all English language articles between 1996 and December 2018 for all articles reporting on endoscopic surgical management for eroded FB following previous sling/mesh procedure for incontinence.

Results: Our search produced 931 articles of which 20 articles (198 patients) were included in our review; 149 (75%) had tension-free vaginal tapes (TVT) or tension-free obturator tapes (TOT) as their initial procedure. The site of mesh erosion was the bladder in 134 patients (68%) of which 12 (6%) were in the bladder neck. Urethral mesh erosion was seen in 63 patients (32%) across all studies. The treatment of eroded mesh was by laser and endoscopic excision using an electrode loop or laparoscopic scissors in 108 (55%) and 90 (45%) patients respectively. The initial/final success rate with laser and endoscopic excision was 67%/92% and 80%/98% respectively. The overall complication rates were 24% and 28% in laser and endoscopic groups respectively of which 21% in each group were stress urinary incontinence.

Conclusions: Endoscopic management of FB erosion is an effective minimally invasive technique with good outcomes and minimal morbidity. Management with the use of holmium laser is gaining momentum and could be attempted before open surgical removal. There is a need for comparative data between open surgical excision and endoscopic excision to help better describe the patient's most likely to benefit from the endoscopic technique.

Keywords: Endoscopic; Endoscopic removal; Endoscopy; Incontinence; Laser; Mesh; Mesh erosion; Sling; TOT; TVT; Tape.

PubMed Disclaimer

Conflict of interest statement

None.

Figures

Fig. 1
Fig. 1
PRISMA flowchart of the included studies
See this image and copyright information in PMC

References

    1. Oliphant SS, Wang L, Bunker CH, Lowder JL. Trends in stress urinary incontinence inpatient procedures in the United States, 1979–2004. Am J Obstet Gynecol. 2009;200:521.e1–521.e6. doi: 10.1016/j.ajog.2009.01.007. - DOI - PMC - PubMed
    1. Koelbl H, Stoerer S, Seliger G, Wolters M. Transurethral penetration of a tension-free vaginal tape. BJOG. 2001;108:763–765. - PubMed
    1. Giri SK, Drumm J, Flood HD. Endoscopic holmium laser excision of intravesical tension-free vaginal tape and poly-propylene suture after anti-incontinence procedures. J Urol. 2005;174(4 Pt 1):1306–1307. doi: 10.1097/01.ju.0000173926.04596.55. - DOI - PubMed
    1. Frenkl TL, Rackley RR, Vasavada SP, Goldman HB. Management of iatrogenic foreign bodies of the bladder and urethra following pelvic floor surgery. Neurourol Urodyn. 2008;27:491–495. doi: 10.1002/nau.20558. - DOI - PubMed
    1. Jo D-J, Lee Y-S, Oh T-H, Ryu D-S, Kwak K-W. Outcomes of transurethral removal of intravesical or intraurethral mesh following midurethral sling surgery. Korean J Urol. 2011;52:829–834. doi: 10.4111/kju.2011.52.12.829. - DOI - PMC - PubMed

Publication types