Transvaginal Sling Excision: Tips and Tricks to Improve Outcomes (Video)

Synthetic midurethral sling placement is the most common procedure performed for women with symptomatic stress urinary incontinence.

Postoperative complications are well-documented in the literature. The estimated rate of sling removal for urethral obstruction is approximately 2.3 percent, and for mesh extrusion is 1.8 percent. However, this may be an underestimate of the true incidence of these complications.

Surgeons at Cleveland Clinic’s Glickman Urological & Kidney Institute perform transvaginal sling excision on patients with evidence of sling obstruction or mesh extrusion.

This video presents three separate cases of synthetic mesh excision and provides tips to improve surgical outcomes in patients. This video was presented at the American Urological Association’s 2016 annual meeting and received an award for best video within its section.

The first patient underwent transobturator sling surgery in 2010 for symptomatic stress incontinence. Postoperatively, she developed voiding dysfunction. Once her catheter was removed, she passed the voiding trial. She was evaluated for urinary hesitancy and weak stream. Her postoperative force of stream was 40 percent of the original.
She presented with urinary hesitancy and weak stream. Her office cystoscopy was negative for mesh perforation, and her urodynamics study showed evidence of outlet obstruction. She elected to proceed with excision of a portion of the sling. Watch the video for detailed, step-by-step surgical instruction of how they treated this patient.
The second case was of a patient who underwent transobturator sling surgery for mixed urinary incontinence and had significant worsening of urgency incontinence postoperatively. The third case discussed was of a patient who underwent sling placement for stress incontinence but whose husband complained of feeling the mesh during sexual intercourse. Watch the video to learn how surgeons handled both cases.