A technique for removal of intravesical tension-free tape and non-absorbable suture after anti-incontinence surgery

Endoscopic removal of intravesical polypropylene suture with plasmakinetic resection after abdominal hysterectomy

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Insertion of polypropylene suture through the base of the bladder after abdominal hysterectomy was not reported yet.

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Since the suture passed both through the base and dome of the bladder, the capacity was restricted and patient suffered from frequency and urgency.

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Use of plasmakinetic energy for removal of intravesical suture was not also reported previously.

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With the aid of plasmakinetic energy loop, bladder mucosa between suture entrance and exit sides was resected in both sides.

INTRODUCTION

Intravesical foreign substances such as mesh or suture are among the rare reasons of recurrent urinary tract infections. Anti-incontinence and prolapsus procedures are associated with mesh/suture extrusion into the bladder, however, this complication is uncommon with abdominal hysterectomy.

PRESENTATION OF CASE

A 61-year-old female, obese patient admitted to our clinic with recurrent urinary tract infections and voiding symptoms which were worsened after abdominal hysterectomy. Radiological evaluation revealed an intravesical foreign material within the bladder. The cytoscopy was performed and a polypropylene suture which was inserted from dome, passed through the base and exited from the dome of bladder during abdominal hysterectomy. Transurethral plasmakinetic resection of superficial layer of urothelium between suture entrance and exit sites was performed and suture was removed from the bladder.

DISCUSSION

Urogynecological procedures are associated with the increased risk of urethral or ureteral injury, intravesical mesh or suture erosion and fistulae formation. Many different techniques including open, laparoscopic and transvaginal approaches were described for the removal of intravesical mesh/suture extrusion in the literature. Transurethral approach with its minimally invasive and safe nature was used to remove suture in this patient. This technique with the use of plasmakinetic energy has the advantage of decreased risk of bleeding and urothelial injury when compared to monopolar cautery. It also avoids the need for open or extensive surgery which may have a high rate of complications.

CONCLUSION

Transurethral resection is the treatment of choice for the removal of intravesical foreign substances. Use of plasmakinetic energy will decrease the risk of complications and avoid the need for open interventions.