Novel endoscopic management of a late complication following TVT insertion for stress urinary incontinence

Patient: Female, 57 Final Diagnosis: Bladder erosion Symptoms: Haematuria • irritative bladder symptoms • recurrent UTI Medication: — Clinical Procedure: Endoscopic tape resection Specialty: Urology OBJECTIVE: Unusual or unexpected effect of treatment BACKGROUND: Since 1995 over 1 million tension free vaginal slings have been utilized to treat stress incontinence. The 10 year success rates range from 84–93%. Complication rates are low by comparision. Bladder perforation occurring during the time of surgery and is managed effectively if diagnosed and treated intraoperatively. However bladder erosion occuring post-operatively predominantly occur within the first 2 years. The risk of erosion increases with body mass index and previous vaginal surgery. CASE REPORT: We report the case of a bladder erosion occurring 5 years following the original surgery. The symptoms included recurrent urinary tract infections, frequency and haematuria. A novel technique was employed using the transurethral approach to initially disintegrate the calculus and then using an endoshears to excise the mesh below the level of the epithelium. Continence was maintained postoperatively. CONCLUSIONS: This approach provides a safe alternative to both the transvaginal and transabdominal approach to excising intravesical mesh.