Transvaginal Excision of Mesh Erosion Involving the Bladder After Mesh Placement Using a Prolapse Kit: A Novel Technique
Received 17 August 2009; accepted 20 August 2009. published online 13 November 2009.
Objectives
To present our initial experience with a pure transvaginal approach for the removal of mesh erosion involving the bladder secondary to placement of transvaginal mesh for management of pelvic organ prolapse using a prolapse kit.
Methods
Transvaginal excision of mesh erosion involving the bladder after mesh placement using a prolapse kit was performed in 2 patients. A U-shaped incision is made in the anterior vaginal wall forming a vaginal wall flap. Mesh is identified, divided in the midline, and then dissected from the bladder. The bladder is closed via a transvaginal approach in 3 layers.
Results
Removal of mesh erosion within the bladder was completed, with all operative steps performed transvaginally in 2 patients. No intraoperative complications occurred. Both patients were discharged with bilateral JJ stents and an 18F Foley catheter. Follow-up cystogram was normal in both patients. There were no major postoperative complications.
Conclusions
Transvaginal removal of mesh erosion involving the bladder is technically feasible. Additional experience is needed to better define patient selection criteria and indications for transvaginal excision of mesh erosion involving pelvic structures.
Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
ABSTRACT