LAPAROSCOPICALLY ASSISTED TRANSVESICAL EXCISION OF TVT MESH   

S.R. Edwards, S. Hamilton Boyles

Oregon Health & Science University, Portland OR.

OBJECTIVE:  To demonstrate a minimally invasive method of laparoscopically assisted cystoscopic mesh removal from erosion of a TVT prolene mesh into the bladder.

MATERIALS AND METHODS:  This 45 year old woman presented with a TVT prolene mesh erosion into both the left lateral vaginal fornix periurethrally and the left side of her bladder superior and lateral to the left ureteral orifice.  This video demonstrates her mesh erosion sites along with the minimally invasive approach employed for mesh resection.  The use of pediatric or microlaparoscopic equipment greatly enhances the surgeon’s ability to manipulate instruments within the bladder.  Integral to the procedure is the ability to visualize and remove all mesh remnants in order to prevent future stone formation.

RESULTS:  Eroded mesh is completely resected from the patient’s vagina and bladder without requiring laparotomy and cystotomy.  She was discharged home on an outpatient basis without complication.

CONCLUSION:  Laparoscopically assisted cystoscopic resection of intravesical mesh from minimally invasive suburethral slings is a successful surgical management option in appropriately selected patients.

Key Words:  TVT mesh, mesh erosion, bladder erosion

Disclosure – Speakers Bureau: R. Edwards, Pfizer, Eli Lilly.