Technical Video: Vesicoscopic Excision of Eroded Tension-free Vaginal Tape

Abstract

Study objective: To show vesicoscopic excision of eroded tension-free vaginal tape (TVT).

Design: A technical video showing vesicoscopic excision of eroded TVT (Canadian Task Force Classification level III).

Setting: Urogynecology and Urology Departments, King's College Hospital, London, UK, a tertiary referral center for urogynecology.

Interventions: A 52-year-old woman presented with suprapubic pain, hematuria, and recurrent urinary tract infections 4 years after TVT insertion for stress urinary incontinence. Cystoscopy revealed exposed tape with calcifications on the right aspect of the bladder. Video urodynamics showed normal bladder function and no stress incontinence. After counseling, she opted to have the portion of tape excised via a vesicoscopic approach.

Conclusion: Exposed tape is found in up to 4% of women who have undergone TVT procedures because of primary unrecognized bladder injury or secondary erosion [1]. Management of this complication can result in a succession of invasive procedures. In this case, vesicoscopy allowed complete excision of the exposed portion of tape. After mobilization, the bladder wall was closed without tension using Mignot-Grange's extracorporeal knotting technique. The stumps of the tape were buried deeply to prevent recurrent erosion. We have used vesicoscopy since 2007 for a variety of female urogynecologic problems including bladder diverticula, ureteric stenosis, vesicoureteric reflux, foreign body, and vesicovaginal fistulae [2]. So far, we have undertaken 5 tape excisions in 4 patients (1 bilateral exposure). Incontinence has not recurred in any of the women. In conclusion, vesicoscopy can facilitate excision of exposed intravesical tape without risking urethral trauma for recurrent tape exposure.

Keywords: Tape erosion; Tension-free vaginal tape; Vesicoscopic surgery.