For a study, researchers sought to identify the symptoms that led to the diagnosis of urethral mesh exposure, explain the surgical therapy, and assess post-operative functional and urodynamic results.
Retrospective observational monocentric study of 15 patients treated by mid-urethral sling removal for urethral exposure at a pelviperineology center between December 2005 and February 2021.
There were 15 patients in all. The average duration from urethral exposure to diagnosis was 43 months. This delay in diagnosis was caused by non-specific symptoms. In all patients, surgical therapy consisted of partially removing the eroded mid-urethral sling piece through the vaginal route with minimal perioperative morbidity. At 3 months, 87% of patients developed stress urinary incontinence, compared to 54% at 2 years. After the mid-urethral sling was removed, 13 patients were evaluated for urodynamics; all of them showed sphincter insufficiency, with urethral closure pressures less than 30 cm H2O. A second urinary incontinence treatment surgery was performed on nine patients, resulting in 77% full remission and 23% partial improvement.
The clinical manifestations of urethral erosion following a mid-urethral sling are variable. However, after a thorough preoperative examination, a two-step management method involving minimally invasive mid-urethral sling removal and treatment of recurrent urine incontinence yields excellent outcomes, with 77% of patients cured. One of the factors that may explain the increased risk of stress urinary incontinence following urethral mesh erosion surgery is sphincter insufficiency.