title: Management of vaginal extrusion after tension-free vaginal tape procedure for urodynamic stress incontinence.
abstract: OBJECTIVE
  To report our experience in the management of vaginal extrusion after the tension-free vaginal tape (TVT) procedure for urodynamic stress incontinence.
  
  
  METHODS
  Five patients diagnosed with vaginal extrusion after a TVT procedure performed at our institution were identified. We reviewed the patients' records retrospectively. The interval from TVT placement to diagnosis, presenting symptoms and signs, duration of symptoms, diagnostic test findings, treatment, and postoperative results were recorded. Patients were followed up for at least 12 months.
  
  
  RESULTS
  From January 2001 to June 2004, a total of 166 patients underwent the TVT procedure. Of these, 5 patients (3%) were diagnosed with isolated vaginal extrusion 4 to 40 months postoperatively. No cases of urethral or bladder erosion occurred in this series. The symptoms included vaginal discharge, pain, bleeding, and dyspareunia. The eroded margin of the vaginal mucosa was trimmed, mobilized, and closed over the tape with interrupted vertical mattress sutures in a single layer using 2-0 polyglactin 910 to avoid mucosal inversion. All patients remained symptom free without any evidence of defective healing or additional extrusion at a minimal follow-up of 12 months.
  
  
  CONCLUSIONS
  Primary reclosure of the vaginal mucosa over the TVT tape is an effective first-line treatment option for vaginal extrusion without compromising continence. Patients undergoing the TVT procedure should be adequately counseled about the possibility of this complication and the available treatment options.
authors.affiliation: Department of Urology, University Hospital, Limerick, Ireland. s21giri@yahoo.co.uk
authors.forename: Subhasis K
authors.initials: SK
authors.lastname: Giri
authors.forename: Debasri
authors.initials: D
authors.lastname: Sil
authors.forename: Girish
authors.initials: G
authors.lastname: Narasimhulu
authors.forename: Hugh D
authors.initials: HD
authors.lastname: Flood
authors.forename: Mark
authors.initials: M
authors.lastname: Skehan
authors.forename: John
authors.initials: J
authors.lastname: Drumm
mesh_terms: D005260:Female; D006801:Humans; D011183:Postoperative Complications; D053825:Suburethral Slings / Q000009:adverse effects*; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D014621:Vagina / Q000293:injuries* / Q000601:surgery*