Polypropylene mesh tape for stress urinary incontinence: complications of urethral erosion and outlet obstruction.
OBJECTIVE
Gynecare tension-free vaginal tape (Ethicon, Inc., New Brunswick, New Jersey) is a propylene mesh tape recently introduced in the United States as minimally invasive treatment for stress urinary incontinence. We report the combined experience at 3 tertiary care institutions with graft erosion and bladder outlet obstruction after procedures performed elsewhere.


METHODS
We reviewed the records of 5 patients with complications who presented to 1 of 3 institutions after polypropylene mesh tape placement. All pertinent information was obtained from the medical records and the operating surgeon at the referring institution.


RESULTS
Treatment was required in 2 patients with urethral erosion, 1 with vaginal and bladder erosion, and 2 with bladder outlet obstruction. Common presenting symptoms included urge, urge incontinence and gross hematuria. Cystoscopy showed polypropylene graft erosion at the urethra or through the bladder wall. Each patient required explantation of the polypropylene mesh tape and further surgery to restore continence. The graft was divided transvaginally in the 2 patients presenting with outlet obstruction. Urge incontinence resolved and they returned to complete spontaneous voiding.


CONCLUSIONS
High clinical suspicion is necessary when evaluating patients presenting with urinary symptoms after polypropylene mesh tape placement. Bladder outlet obstruction and possible graft erosion should be considered.
Sweat
Susan D
SD
Department of Urology, University of Michigan Medical Center, Ann Arbor, Michigan, USA.
Itano
Nancy B
NB
Clemens
J Quentin
JQ
Bushman
Wade
W
Gruenenfelder
Jennifer
J
McGuire
Edward J
EJ
Lightner
Deborah J
DJ
D000328:Adult; D003558:Cystoscopy; D004868:Equipment Failure; D005260:Female; D006801:Humans; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D011126:Polypropylenes / Q000009:adverse effects*; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D012086:Reoperation; D013526:Surgical Mesh / Q000009:adverse effects*; D014521:Urethra / Q000293:injuries* / Q000473:pathology; D001748:Urinary Bladder Neck Obstruction / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D014550:Urinary Incontinence, Stress / Q000601:surgery*
D011126:Polypropylenes