title: Urethral erosion of tension-free vaginal tape presenting as recurrent stress urinary incontinence.
abstract: The suburethral sling with tension-free vaginal tape (TVT) has become a popular treatment for stress urinary incontinence. Erosion of the mesh into the urethra is rare, usually presenting with hematuria, pain, voiding dysfunction or urge incontinence. A patient with stress incontinence was treated with a TVT suburethral sling. One month later, symptoms of recurrent stress incontinence developed. Cystourethroscopy revealed urethral mesh erosion. Surgical removal involved cystourethroscopic-assisted transurethral resection of the mesh, followed by vaginal dissection and periurethral withdrawal. Urethral mesh erosion should be considered in a patient who presents with atypical symptoms after being treated with a suburethral sling. It is important to obtain a detailed history and have a high clinical index of suspicion for erosion. Careful and comprehensive urethroscopy, in addition to cystoscopy, should be a mandatory part of the TVT procedure. Further study is needed to determine the optimal technique for mesh removal.
authors.affiliation: Division of Urogynecology/Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX 75390-9032, USA. clifford.wai@utsouthwestern.edu
authors.forename: Clifford Y
authors.initials: CY
authors.lastname: Wai
authors.forename: Shanna D
authors.initials: SD
authors.lastname: Atnip
authors.forename: Kristin N
authors.initials: KN
authors.lastname: Williams
authors.forename: Joseph I
authors.initials: JI
authors.lastname: Schaffer
mesh_terms: D003937:Diagnosis, Differential; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects; D006801:Humans; D007044:Hysterectomy; D008875:Middle Aged; D019736:Prostheses and Implants / Q000009:adverse effects; D011475:Prosthesis Failure; D012008:Recurrence; D013526:Surgical Mesh / Q000009:adverse effects; D014522:Urethral Diseases / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology / Q000601:surgery; D014550:Urinary Incontinence, Stress / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology / Q000601:surgery; D014623:Vaginal Diseases / Q000601:surgery*