Urethral complications after tension-free vaginal tape procedures: A surgical management case series

Table 1 Background factors for patients with urethral erosion after tension-free vaginal tape procedure

Case	Age (yr)	Parity	BMI	Menopause	Previous operations	Postoperative medical history	Primary operation
Case 1	46	2	23.0	Hormone IUD (Mirena®)	Appendectomy	No	TVT-O, Gynecare®
Case 2	55	2	40.7	Yes	No	Gastric by-pass	TVT-O, Gynecare®
Case 3	60	3	24.1	Yes	No	Pacemaker	TVT-O, Gynecare®
Case 4	43	2	26.1	No	No	No	TVT-Secure, Gynecare®
Case 5	38	5	36.2	No	Laparoscopic sterilization, Re-sterilization because of ectopic pregnancy	Hysteroscopy, vaginal hysterectomy	TVT-retropubic, Gynecare®
Case 6	48	4	35.3	No	Laparoscopic sterilization	No	MinArcTM, AMS®
Case 7	44	3	29.7	No	Appendectomy	No	TVT-retropubic, Gynecare®
Case 8	40	1	21.3	No	No	Abdominal total hysterectomy and bilateral salpingo-oophorectomy for ovarian mass, re-laparotomy because of ileus	TVT-retropubic, Gynecare®
Case 9	66	2	26.0	Yes	Abdominal hysterectomy, pelvic organ prolapse procedure	Laparoscopic operation of adhesions	TVT-retropubic, Gynecare®

BMI: Body mass index; IUD: Intrauterine device; TVT: Tension-free vaginal tape; TVT-O: Trans-obturator inside-out procedure.

Table 2 Clinical symptoms of urethral erosion and outcomes after the intraurethral mesh was removed

Case	Interval for diagnosis	Early-onsetsymptoms(< 12 mo)	Late-onset symptoms(> 12 mo)	Interval forsurgicalmanagement	Outcome aftersurgicalmanagement	Further treatment
Case 1	5 mo	Urinary retention/voiding dysfunction, UTI, urethral pain (urethritis), de novo urgency, dyspareunia	_	5 mo	Improved urgency, voiding dysfunction resolved, relapse of SUI	Anticholinergic, incontinence pad, electric stimulation, two macroplasty procedures, laparoscopic Burch
Case 2	3 mo	Urethral pain (urethritis), worsening of urgency	_	3 mo	Worsening of urge incontinence, relapse of SUI, recurrent urethritis	Anticholinergic, local antibiotics into the urethra, no further SUI treatments
Case 3	1 yr 8 mo	Urinary retention/voiding dysfunction	De novo urgency, recurrent UTI, vaginal pain	1 yr 11 mo	Urgency resolved, vaginal pain resolved	No further SUI treatments
Case 4	2 mo	De novo urgency, urethral pain (urethritis), vaginal pain, dyspareunia	_	1 yr 8 mo	Improved urgency, urethral pain resolved, relapse of SUI	Anticholinergic, retropubic TVT
Case 5	11 yr 1 mo	Urinary retention/voiding dysfunction, UTI, voiding pain (urethritis)	Relapse of SUI, hematuria after TVT-O	12 yr 2 mo	Recurrent minor SUI (patient already had second incontinence operation), improved urgency, urethral pain, voiding dysfunction resolved	No further SUI treatments
Case 6	8 mo	Urinary retention/voiding dysfunction, direct relapse of SUI, UTI	_	10 mo	Same as before the surgical management	Retropubic TVT
Case 7	9 yr 1 mo	_	Recurrent UTI, de novo urgency, nocturia	9 yr 2 mo	Slight relapse of SUI, improved urgency and voiding dysfunction	Local estrogens, no further SUI treatments
Case 8	7 yr 8 mo	_	Relapse of SUI, minor de novo urgency, nocturia	7 yr 9 mo	Same as before surgical management	Retropubic TVT
Case 9	4 mo	De novo urgency	_	7 mo	Improved urgency, cured SUI, no relapse after the surgical management	No further SUI treatments

SUI: Stress urinary incontinence; TVT: Tension-free vaginal tape; TVT-O: Trans-obturator inside-out procedure; UTI: Urinary tract infection.