Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Nephrol. Jul 6, 2015; 4(3): 396-405
Published online Jul 6, 2015. doi: 10.5527/wjn.v4.i3.396
Urethral complications after tension-free vaginal tape procedures: A surgical management case series
Fotios Sergouniotis, Björn Jarlshammar, Per-Göran Larsson
Fotios Sergouniotis, Per-Göran Larsson, Department of Obstetrics and Gynecology, Skaraborg Hospital, SE-541 85 Skövde, Sweden
Björn Jarlshammar, Department of Urology, Skaraborg Hospital, SE-541 85 Skövde, Sweden
Author contributions: Larsson PG and Jarlshammar B performed the surgical management of all cases; Sergouniotis F performed the follow-up urethrocystoscopy; all authors contributed to the drafting and approval of the manuscript.
Ethics approval statement: No ethical approval was required for this case-report series after contacting the Gothenburg Regional Ethical Committee.
Informed consent statement: All study participants provided informed verbal consent prior to the study enrollment, which was obtained at the visits for postoperative follow-up urethrocystoscopy following the tape removal. The patients encouraged us to report the complications, to prevent others from suffering.
Conflict-of-interest statement: All the authors declare no conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Fotios Sergouniotis, MD, Department of Obstetrics and Gynecology, Skaraborg Hospital, Lövängsvägen, SE-541 85 Skövde, Sweden. fotios.sergouniotis@vgregion.se
Telephone: +46-73-9726594 Fax: +46-50-0431454
Received: December 18, 2014
Peer-review started: December 18, 2014
First decision: January 20, 2015
Revised: February 25, 2015
Accepted: April 10, 2015
Article in press: April 14, 2015
Published online: July 6, 2015
Processing time: 200 Days and 10.6 Hours
Abstract

AIM: To analyze the clinical features, diagnostic modalities, and the surgical management of urethral complications after tension-free vaginal tape procedures.

METHODS: This study encompasses a retrospective review of nine patients presented with urethral complications after midurethral sling procedures. The patients underwent the procedures during a period from 1999 to 2012 in three different regional hospitals in the southwest part of Sweden. The time from sling placement to diagnosis, the risk factors, clinical features, diagnosis, surgical management, and functional outcome are presented. The presenting symptoms were described as either early onset (< 12 mo) or late onset (> 12 mo) according to when they were first reported.

RESULTS: Eight cases of urethral erosion and one case of bladder-neck erosion were detected. The mean interval for diagnoses of the erosions ranged from 3 mo to 11 years. The most common presenting symptoms included de novo urgency with or without incontinence (7/9 patients), urinary retention/voiding dysfunction (4/9 patients), urethritis (4/9 patients), relapse of stress-incontinence (3/9 patients), recurrent urinary tract infections (5/9 patients), and hematuria (1/9 patient). In most cases, voiding dysfunction and urethritis occurred early after the operation. The surgical management applied in most cases was transurethral resection of the intraurethral part of the mesh. The removal of the intraurethral mesh resulted in improvement or complete cure of urgency symptoms in 5/7 patients with urgency. Four patients were reoperated with a new stress-incontinence surgery, one with laparoscopic Burch, and three with retropubic tension-free vaginal tape procedures.

CONCLUSION: Urethral complications should be suspected in the case of de novo urgency and relapse of stress-incontinence. Transurethral excision of the intraurethral mesh is the recommended treatment.

Keywords: Bladder neck erosion; Complications; Intraurethral mesh; Stress incontinence; Tension-free vaginal tape; Urethral erosion

Core tip: We present eight cases of urethral erosion and one of bladder neck erosion after tension-free vaginal tape procedures. The mean interval for complication diagnoses ranged from 3 mo to 11 years. The clinical profile of the complications included de novo urgency, voiding dysfunction, urethritis, relapse of stress incontinence, recurrent urinary tract infections, and hematuria. It is important to consider urethral complications in the postoperative follow-up if these symptoms occur. A control urethrocystoscopy is important for the diagnosis. The transurethral excision of the intraurethral part of the mesh is recommended as the treatment of choice.