title: Vaginal mucosal flap as a sling preservation for the treatment of vaginal exposure of mesh.
abstract: OBJECTIVE
  Tension-free vaginal tape (TVT) procedures are used for the treatment of stress urinary incontinence in women. The procedures with synthetic materials can have a risk of vaginal erosion. We experienced transobturator suburethral sling (TOT) tape-induced vaginal erosion and report the efficacy of a vaginal mucosal covering technique.
  
  
  METHODS
  A total of 560 female patients diagnosed with stress urinary incontinence underwent TOT procedures at our hospital between January 2005 and August 2009. All patients succeeded in follow-ups, among which 8 patients (mean age: 50.5 years) presented with vaginal exposure of the mesh. A vaginal mucosal covering technique was performed under local anesthesia after administration of antibiotics and vaginal wound dressings for 3-4 days.
  
  
  RESULTS
  Seven of the 8 patients complained of persistent vaginal discharge postoperatively. Two of the 8 patients complained of dyspareunia of their male partners. The one remaining patient was otherwise asymptomatic, but mesh erosion was discovered at the routine follow-up visit. Six of the 8 patients showed complete mucosal covering of the mesh after the operation (mean follow-up period: 16 moths). Vaginal mucosal erosion recurred in 2 patients, and the mesh was then partially removed. One patient had recurrent stress urinary incontinence.
  
  
  CONCLUSIONS
  Vaginal mucosal covering as a sling preservation with continued patient continence may be a feasible and effective option for the treatment of vaginal exposure of mesh after TOT tape procedures.
authors.affiliation: Department of Urology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea.
authors.forename: Sea Young
authors.initials: SY
authors.lastname: Kim
authors.forename: Jong Yeon
authors.initials: JY
authors.lastname: Park
authors.forename: Han Kwon
authors.initials: HK
authors.lastname: Kim
authors.forename: Chang Hoo
authors.initials: CH
authors.lastname: Park
authors.forename: Sung Jin
authors.initials: SJ
authors.lastname: Kim
authors.forename: Gi Teck
authors.initials: GT
authors.lastname: Sung
authors.forename: Chang Myon
authors.initials: CM
authors.lastname: Park