title: Removal of Polypropylene Sling Mesh From the Urethra: An Anatomic Technique.
abstract: OBJECTIVE
  To describe a technique for removal of intraurethral mesh with minimal disruption of the periurethral anatomy.
  
  
  METHODS
  Through a midline transvaginal approach the sling is located lateral to the urethra and divided. The medial portion of the divided sling is carefully dissected back to its entrance laterally into the urethral lumen. A stay suture is placed on the dissected sling. The sling is located on the contralateral side and likewise divided and dissected back to the urethral lumen. The completely dissected sling is pulled through such that the holding stitch is through and through the urethral lumen, allowing easy localization of the urethral defect on lateral walls of the urethra. These defects are closed with an absorbable suture and the vaginal incision is closed.
  
  
  RESULTS
  Three patients have undergone a transvaginal removal of their intraurethral mesh using the described technique. At a mean follow-up of 6.0 months, there were no intraoperative or postoperative complications. All patients were obstructed preoperatively and all developed stress urinary incontinence postoperatively requiring 0-1 pads per day.
  
  
  CONCLUSIONS
  Current approaches to the surgical repair of chronic intraurethral mesh have significant limitations that are minimized by the described technique. This anatomic removal of mesh from the urethra has several advantages including no disruption of the ventral wall of the urethra, complete removal of foreign body from the urethra, and simplified localization of the urethral wall defect to allow for anatomic closure.
authors.affiliation: Department of Urology, Medical University of South Carolina, Charleston, SC.
authors.forename: Drew A
authors.initials: DA
authors.lastname: Freilich
authors.affiliation: Department of Urology, Medical University of South Carolina, Charleston, SC. Electronic address: Rovnere@musc.edu.
authors.forename: Eric S
authors.initials: ES
authors.lastname: Rovner
mesh_terms: D020878:Device Removal / Q000379:methods*; D005260:Female; D006801:Humans; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D011126:Polypropylenes; D053825:Suburethral Slings; D013526:Surgical Mesh; D014521:Urethra / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods*; D014621:Vagina
chemical_list: D011126:Polypropylenes