Laparoscopic transvesical excision and reconstruction in the management of mid-urethral tape mesh erosion and stones around the bladder neck: initial experiences

Abstract

OBJECTIVES To evaluate laparoscopic transvesical excision and reconstruction for the management of vesical mesh or stones around the bladder neck as complications of anti-incontinence intervention. To compare the techniques, outcomes and recurrence rates of laparoscopic transvesical excision and reconstruction with published results from studies using laparoscopic transvesical procedures. PATIENTS AND METHODS We conducted a retrospective review of three patients who underwent laparoscopic transvesical excision and reconstruction for vesical mesh and stones around the bladder neck. Patients were identified from operating records including recorded video and electronic data records. We also conducted a literature review of the available evidence on transvesical laparoscopy for lower urinary tract complications of anti-incontinence procedures. RESULTS Between March 2005 and May 2011, three women underwent laparoscopic transvesical excision and reconstruction. All presented with storage symptoms and gross haematuria. The interval between surgery and the diagnosis of presence of a foreign body was 1-3 years. Two women had previously undergone transobturator tape procedures and one had undergone a retropubic procedure. Complete excision including the mucosa and muscle layer and reconstruction with intravesical sutures was achieved in all cases. Storage symptoms were resolved within 3 days and haematuria was not observed. None of the women had recurrent erosion at follow-up. CONCLUSIONS Laparoscopic transvesical excision and reconstruction is a technically feasible method. This procedure offers excellent visualization of mesh materials and stones, especially in cases of location near the anterior bladder neck. In selected patients, laparoscopic transvesical excision and reconstruction is an acceptable technique for first-line treatment of complications of anti-incontinence procedures.