title: Transvaginal sling excision: tips and tricks.
abstract: OBJECTIVE
  Complications of synthetic midurethral sling surgery include bladder outlet obstruction, mesh extrusion, and vaginal pain. A treatment of these complications is transvaginal mesh removal. The objectives of this video are to present cases of complications after sling placement and describe techniques to help with successful sling removal.
  
  
  METHODS
  Three patients are presented in this video. One experienced urinary hesitancy and was found to have bladder outlet obstruction on urodynamic study. The second patient presented to the clinic with diminished force of stream and significant dyspareunia. The last patient presented with mesh extrusion. After discussion of management options, all three patients wished to pursue transvaginal sling excision.
  
  
  RESULTS
  All patients had successful removal of a portion of their synthetic midurethral sling. This video presents techniques to aide with dissection, mesh excision and prevention of further mesh complications. These include using an individualized surgical technique based on patient presentation and surgeon expertise, planning surgical incisions based on where mesh can be identified or palpated, using a cystoscope sheath or urethral dilator to identify any bladder outlet obstruction, and using a knife blade to identify mesh from surrounding tissue.
  
  
  CONCLUSIONS
  Sling excision can be successfully performed with careful surgical technique and dissection.
authors.affiliation: Department of Urology, Cleveland Clinic, 9500 Euclid Avenue/ Q10-1, Cleveland, OH, 44195, USA. marisameyerclifton@gmail.com.
authors.forename: Marisa M
authors.initials: MM
authors.lastname: Clifton
authors.affiliation: Department of Urology, Cleveland Clinic, 9500 Euclid Avenue/ Q10-1, Cleveland, OH, 44195, USA.
authors.forename: Howard B
authors.initials: HB
authors.lastname: Goldman
mesh_terms: D000328:Adult; D020878:Device Removal / Q000379:methods*; D004414:Dyspareunia / Q000209:etiology / Q000601:surgery; D005260:Female; D006801:Humans; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery*; D053825:Suburethral Slings / Q000009:adverse effects*; D013526:Surgical Mesh / Q000009:adverse effects; D016896:Treatment Outcome; D001748:Urinary Bladder Neck Obstruction / Q000209:etiology / Q000601:surgery; D014621:Vagina / Q000601:surgery*
keywords: Foreign-body migration; Suburethral sling; Urethra, surgical mesh; Vaginal surgery