To identify symptoms leading to urethral mesh exposure diagnosis, describe the surgical management and evaluate post-operative functional and urodynamic outcomes.
Retrospective observational monocentric study of 15 patients treated by mid-urethral sling removal for urethral exposure, between December 2005 and February 2021, in a pelviperineology centre.
Fifteen patients were included. The mean time to diagnosis of urethral exposure was 43 months. This diagnosis delay was caused by a non-specific symptomatology. Surgical management consisted of partial removal of the eroded mid-urethral sling fragment by vaginal approach in all cases, with low peri-operative morbidity. At three months follow-up, 87% of the patients had stress urinary incontinence versus 54% at two years. 13 patients had a urodynamic assessment after their mid-urethral sling removal, they all had sphincter insufficiency with a urethral closure pressure lower than 30 cm H2O. Nine patients underwent a second urinary incontinence management procedure, leading to 77% of complete remission and 23% of partial improvement.
Clinical presentation of urethral erosion after mid-urethral sling is heterogeneous. Surgical management is complex; after a good preoperative evaluation, a two-step management strategy including minimally invasive mid-urethral sling removal and treatment of recurrent urinary incontinence leads to good results with 77% of patients cured. Sphincter insufficiency is one of the mechanisms that may explain the high rate of stress urinary incontinence after urethral mesh erosion surgery.
Urology. 2022 Jan 20 [Epub ahead of print]
Nicolas Hermieu, Idir Ouzaid, Rana Aoun, Evanguelos Xylinas, Jean-François Hermieu, Nadja Schoentgen
Department of Urology, Bichat Claude Bernard Hospital, Paris, France University of Paris, Paris, France,. Electronic address: ., Department of Urology, Bichat Claude Bernard Hospital, Paris, France University of Paris, Paris, France,. Electronic address: ., Department of Urology, Bichat Claude Bernard Hospital, Paris, France,. Electronic address: ., Department of Urology, Bichat Claude Bernard Hospital, Paris, France University of Paris, Paris, France,. Electronic address: ., Department of Urology, Bichat Claude Bernard Hospital, Paris, France University of Paris, Paris, France,. Electronic address: ., Department of Urology, Bichat Claude Bernard Hospital, Paris, France,. Electronic address: .