Tension-free vaginal tape sling with a porcine interposition graft in an irradiated patient with a past history of a urethrovaginal fistula and urethral mesh erosion: a case report.
BACKGROUND
Patients with previous irradiation are at high risk for complications following pelvic reconstructive surgery. The treatment of these complications and the patient's initial disorder can be complex and difficult, especially when the use of various graft materials, including mesh, is involved in the original complication.


METHODS
A 49-year-old woman with a history of anal and vulvar cancer treated with pelvic irradiation underwent a tension-free vaginal tape (TVT) sling for stress urinary incontinence (SUI) and experienced complications of urethral mesh erosion and urethrovaginal fistula (UVF). The mesh was removed and the urethra repaired, but the repair failed, and she continued to have a persistent UVF. The patient presented to our center, and the UVF was repaired successfully with a Martius flap. Secondary to persistent SUI with intrinsic sphincter deficiency (ISD), the patient underwent a repeat TVT sling with a porcine interposition graft between the mesh and urethra to help prevent urethral mesh erosion. The patient healed without complications and achieved 80% improvement in her symptoms at 3 months, with only occasional SUI. She was eventually able to achieve 100% cure with the addition of periurethral collagen injections.


CONCLUSIONS
Porcine interposition grafts while constructing a TVT sling may help reduce urethral erosion rates in patients with previous irradiation.
Lowman
Joye
J
Urogynecology Associates, Indiana University/Purdue University, Indianapolis, Indiana, USA. jlowman@amh.org
Moore
Robert D
RD
Miklos
John R
JR
D000818:Animals; D001705:Bioprosthesis; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods; D006801:Humans; D008875:Middle Aged; D011832:Radiation Injuries / Q000150:complications; D016038:Skin Transplantation / Q000379:methods*; D053825:Suburethral Slings; D013526:Surgical Mesh / Q000009:adverse effects; D013552:Swine; D014183:Transplantation, Heterologous; D014522:Urethral Diseases / Q000601:surgery*; D014548:Urinary Fistula / Q000601:surgery*; D014550:Urinary Incontinence, Stress / Q000601:surgery; D013521:Urologic Surgical Procedures, Male / Q000379:methods; D014624:Vaginal Fistula / Q000601:surgery*