Abstract：Objective: To investigate the cause, diagnosis, treatment and prevention of the urethral mesh erosion after tension-free vaginal tape obturator (TVT-O). Methods: One case of the urethral mesh erosion after TVT-O was introduced, and relevant literatures were reviewed. The cause, diagnosis, treatment and prevention of urethral erosion were comprehensively analyzed combined with this case. Results: Exploration and excision of mesh eroded in urethra assisted by cystoscope was applied for this patient. The operation was successfully performed and postoperative recovery was good. Her symptoms including foreign body sensation in perineum and odynuria disappeared, but the stress urinary incontinence relapsed 1 week after operation. Conclusions: The urethral mesh erosion after TVT-O has some possible causes and the symptoms of performance have great difference. The diagnosis is made by cystoscopy. Excision of mesh by cystoscope or assisted by cystoscope is the first choice. Research and development of the TVT-O system and attention to intraoperative standardized operation are the keys of preventing this complication.
[1] Robinson D, Staskin D, Laterza RM, et al.Defining female voiding dysfunction: ICI-RS 2011. Neurourol Urodyn, 2012,31(3):313-316. [2] de Leval J, Bonnet P, Reul O, et al. Novel surgical technique for the treatment of female stress urinary incontinence: transobturator vaginal tape inside-out. Eur Urol, 2004,3(2):724-730. [3] DeLancey JO. Structural support of the urethra as it relates to stress urinary incontinence: the hammock hypothesis. Am J Obstet Gynecolon, 1994,170(6):1720-1723. [4] Ulmsten U, Henriksson L, Johnson P, et al. An ambulatory surgical procedure under local anesthesia for treatment of female urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct, 1996,7(2):81-85,discussion 85-86. [5] Meschia M, Pifarotti P, Bernasconi F, et al.Tension-free vaginal tape (TVT) and intravaginal slingplasty (IVS) for stress urinary incontinence: a multicenter randomized trial. Am J Obstet Gynecol, 2006,195(5):1338-1342. [6] Nilsson CG, Palva K, Rezapour M, et al.Eleven years prospective follow-up of the tension-free vaginal tape procedure for treatment of stress urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct,2008,19(8):1043-1047. [7] Delorme E.Transobturator urethral suspension: mini-invasive procedure in the treatment of stress urinary incontinence in women. Prog Urol, 2001,11(6):1306-1313. [8] Stavros C, Ioannis V, Vasileios SI, et al.Comparison of TVT, TVT-O/TOT and mini slings for the treatment of female stress urinary incontinence: 30 months follow up in 531 patients. Arch Ital Urol Androl, 2012,84(3):129-136. [9] Blaivas JG, Sandhu J.Urethral Reconstruction after erosion of slings in women. Curr Opin Urol, 2004,14(6):335-338. [10] 李丽. 聚丙烯吊带材料学特征及在张力性尿失禁中的应用.中国组织工程研究与临床康复,2014,29(14):5415-5418. [11] 王毅,于德新,谢栋栋,等.TVT-O术并发症的预防与治疗.安徽医学,2014,35(5):596-598. [12] Shah HN, Badlani GH.Mesh complications in female pelvic floor reconstructive surgery and their management: A systematic review. Indian J Urol, 2012, 28(2): 129-153. [13] 史宏晖,朱兰,郎景和.阴道无张力吊带悬吊术后网带侵蚀8例分析.实用妇产科杂志,2010,26(12):909-911. [14] Wijffels SA, Elzevier HW, Lycklama a Nijeholt AA. Transurethral mesh resection after urethral erosion of tension-free vaginal tape: report of three cases and review of literature. Int Urogynecol J Pelvic Floor Dysfunct, 2009,20(2):261-3. [15] Mendonça TM, Martinho D, Dos Reis JP.Late urethral erosion of transobturator suburethral mesh (Obtape): a minimally invasive management under local anaesthesia. Int Urogynecol J, 2011,22(1):37-39. [16] Parekh MH, Minassian VA, Poplawsky D.Bilateral bladder erosion of a transobturator tape mesh. Obstet Gynecol, 2006,108(3 Pt 2):713-715. [17] Baracat F, Mitre AI, Kanashiro H, et al.Endoscopic treatment of vesical and urethral perforations after tension-free vaginal tape (TVT) procedure for female stress urinary incontinence. Clinics (Sao Paulo), 2005,60(5):397-400. [18] Oh TH, Ryu DS.Transurethral resection of intravesical mesh after midurethral sling procedures. J Endourol, 2009,23(8):1333-1337. [19] Foley C, Patki P, Boustead G.Unrecognized bladder perforation with mid-urethral slings. BJU Int, 2010,106(10):1514-1518. [20] Angulo JC, Mateo E, Lista F, et al.Reconstructive treatment of female urethral estenosis secondary to erosion by suburethral tape. Actas Urol Esp, 2011,35(4):240-245. [21] Al-Wadi K, Al-Badr A.Martius graft for the management of tension-free vaginal tape vaginal erosion. Obstet Gynecol, 2009,114(2 Pt 2):489-491. [22] Mortimer A, Khunda A, Ballard P.Martius graft for TOT extrusion: a case series. Int Urogynecol J, 2016,27(1):113-116. [23] 张瑜,顾颖,李虹.延迟可吸收吊带与永久非吸收吊带治疗压力性尿失禁的治疗效果比较.临床和实验医学杂志,2015,14(24):2083-2085. [24] Mostafa A, Agur W, Abdel-All M, et al.A multicentre prospective randomised study of single-incision mini-sling (Ajust (R)) versus tension-free vaginal tape-obturator (TVT-O (TM)) in the management of female stress urinary incontinence: pain profile and short-term outcomes. Eur J Obstet Gynecol Reprod Biol, 2012,165(1):115-121. [25] 杨军,张景宇.TVT-O治疗女性压力性尿失禁46例报告.临床泌尿外科杂志,2013,38(8):573-577.
