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. 2023 Jun;34(6):1329-1331.
doi: 10.1007/s00192-023-05495-4. Epub 2023 Mar 11.

Vaginal and laparoscopic sub-urethral sling explantation

Virginie Collin-Bund  1   2 , Victor Gabriele  3 , Chris Minella  3 , Lise Lecointre  3 , Thomas Boisramé  3 , Emilie Faller  3 , Aline Host  3 , Chérif Akladios  3 , Christian Saussine  4 , Olivier Garbin  3
Affiliations

Vaginal and laparoscopic sub-urethral sling explantation

Virginie Collin-Bund et al. Int Urogynecol J. 2023 Jun.

Abstract

Introduction and hypothesis: The objective was to describe the different laparoscopic and vaginal steps of sub-urethral infected mesh explantation as well as an unexpected and unusual complication: a sub-mucosal calcification on the sub-urethral segment of the sling that was not infiltrating the urethra.

Methods: This was carried out at our University Teaching Hospital of Strasbourg.

Results: We show the complete removal of an infected retropubic sling in a patient who had already undergone three previous surgeries without resolution of symptoms. This is a difficult case requiring a laparoscopic approach of the space of Retzius, which has been less familiar to surgeons since the advent of the midurethral sling. We show how to approach this space in an inflammatory environment by specifying its anatomical limits. Moreover, a great deal can be learned from the occurrence of an infectious complication after the surgery and the presence of a large calcification on the prosthesis. In this context, we advise a systematic antibiotic treatment to avoid this kind of complication.

Conclusions: Knowing the guidelines and the different surgical steps will help urogynecological surgeons to perform similar procedures in patients requiring removal of retropubic slings for complications such as infection and pain, where conservative management has not been successful. These cases must be discussed in a multidisciplinary meeting, as recommended by the French National Authority for Health, and managed in an expert establishment.

Keywords: Laparoscopic surgery; Retzius space; Suburethral sling; Vaginal surgery.

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Conflict of interest statement

All authors have approved the manuscript and agreed to submit it to the International Urogynecology Journal. The authors have no conflicts of interest to declare. The local institutional review board has approved the video.

None.

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