Resident The Smith Institute for Urology at Northwell Health
Introduction: The rate of sling erosion after midurethral placemenet is as low as 0.64% in one study. When present, urethral exposure of mesh is typically managed via endoscpic resection or open removal and urethroplaty with or without autologous fascial sling placement. There is limited literature surrounding complete urethral erosion with obliteration of the urethra.
Methods: 73 F with history of prior urethral sling placement at an outside hospital without avaialbe records presented with urinary retention. In the emergency room, multiple attempts at catheterization had failed. Cystoscopy revelade a completely eroded mesh, and a suprapubic tube was placed. Preop antegrade cystoscopy revealed a completed obliterated urehtra without erosion of mesh into the bladder. Synchronous excision of th eroded vaginal mesh sling and urethroplasty was performed.
Results: At two month follow-up, patient was using one pad per day for mild urge incontinenence. Patient endorsed voiding every two hours during the day and nocturia three time per night.
Conclusions: Erosion of a midurethral sling into the urethra or bladder is rate. Concurrent cystoscopy and calibration of the urethra with sounds or probes can help identify the area of erosion and the extent of the urethra. Synchronous excision of old sling and urethral repair can be performed with good continence outcomes. Persistent SUI following mesh excision and urethroplast can be treated via staged fascial PVS or via bulkamid.