Uretrolisis transvaginal tras cirugía correctora de la incontinencia urinaria de esfuerzo

Salvage surgery after failed treatment of synthetic mesh sling complications

PURPOSE

We report our experience with the diagnosis and treatment of refractory synthetic sling complications in women.

MATERIALS AND METHODS

This is a retrospective study of consecutive women with failed treatments for mesh sling complications. Before and after surgery the patients completed validated questionnaires and voiding diaries, and underwent uroflow with post-void residuals, pad test, cystourethroscopy and videourodynamic studies. Treatment was individualized, and results were subdivided into the 2 groups of conditions and symptoms. Outcomes were assessed with the Patient Global Impression of Improvement with success classified as a score of 1, improvement as 2 to 3 and failure as 4 to 7.

RESULTS

A total of 47 women 35 to 83 years old (mean 60) had undergone at least 1 prior operation (range 1 to 4) to correct sling complications. Original sling composition was type 1 mesh in 36 patients and types 2 and 3 in 11. Surgical procedures included sling incision, sling excision, urethrolysis, urethral reconstruction, ureteroneocystotomy, cystectomy and urinary diversion, and enterocystoplasty. Median followup was 2 years (range 0.25 to 12, mean 3). Overall a successful outcome was achieved in 34 of 47 patients (72%) after the first salvage surgery. Reasons for failure were multiple for each patient. Of the 13 patients with treatment failure 9 subsequently underwent 14 operations. Success/improvement was achieved in 5 women (56%) after continent urinary diversion (1), continent urinary diversion and cystectomy (1), partial cystectomy and augmentation cystoplasty (1), biological sling and sinus tract excision (1), and vaginal mesh excision (1).

CONCLUSIONS

Success after the initial failure of mesh sling complications repair is possible but multiple surgeries may be required. Each symptom should be addressed separately.

[The Martius flap in stress urinary incontinence treated by suburethral sling]

OBJECTIVE

Study of a series of patients treated with suburethral tapes using the Martius flap technique, for complications or in a preventive way, in order to determine its interest and morbidity.

PATIENTS

Eleven female patients treated by suburethral tapes for stress urinary incontinence, for which we described the type of tapes used, their complications, the procedure including Martius flap and the outcomes.

RESULTS

Indications of the Martius flap were: three tapes through bladder neck, one through urethra, one uro-vaginal fistula, four loss of substance of the vaginal wall, one peri-urethral fibrosis and one preventive use on irradiated pelvis. Complications were transient postoperative pain and one abscess of the greater lip. In our series, the Martius flap never cured stress urinary incontinence. The placement of a suburethral tape on a Martius flap is feasible but the adjustment is more difficult.

CONCLUSION

The Martius flap is efficient in the treatment or prevention of suburethral tapes complications with low morbidity. It allows secondary placement of a suburethral tape with difficult adjustment.

Use of a tissue expander to aid in a second urethrolysis: a case report

OBJECTIVES

To describe a novel approach of retropubic urethrolysis using placement of a tissue expander to prevent rescarring after previously failed vaginal urethrolysis in a patient with known extensive scar tissue.