Road to recovery after transvaginal surgery for urethral mesh perforation: evaluation of outcomes and subsequent procedures

Int Urogynecol J. 2018 Jun;29(6):887-892. doi: 10.1007/s00192-018-3563-0. Epub 2018 Jan 29.


Introduction and hypothesis: Urethral injury resulting from transvaginal mesh slings is a rare complication with an estimated incidence of <1%. Our objective was to review the surgical management and functional outcomes of women presenting with urethral mesh perforation following midurethral sling (MUS) placement.

Methods: This was a retrospective multicenter review of women who from January 2011 to March 2016 at two institutions underwent mesh sling excision for urethral perforation with Female Pelvic Medicine and Reconstructive Surgery fellowship-trained surgeons. Data comprising preoperative symptoms, operative details, and postoperative outcomes were collected by telephone (n 13) or based on their last follow-up appointment.

Results obtained: Nineteen women underwent transvaginal sling excision for urethral mesh perforation. Eight (42%) patients had undergone previous sling revision surgery. Sixty percent of women had resolution of their pelvic pain postoperatively. At follow-up, 92% reported urinary incontinence (UI), and three had undergone five additional procedures for vaginal prolapse mesh exposure (n 1), incontinence (onabotulinum toxin injection n 1, rectus fascia autologous sling n 1), prolapse (colpopexy n 1), and pain (trigger-point injection n 1). Patient global impression of improvement data was available for 13 patients, of whom seven (54%) rated their postoperative condition as Very much better or Much better.

Conclusions: The management of urethral mesh perforation is complex. Most women reported resolution of their pelvic pain and a high rate of satisfaction with their postoperative condition despite high rates of incontinence.

Keywords: Midurethral sling; Postoperative complications; Surgical mesh; Urethral reconstruction.

MeSH terms

  • Adult
  • Aged
  • Female
  • Humans
  • Male
  • Middle Aged
  • Retrospective Studies
  • Suburethral Slings / adverse effects*
  • Surgical Mesh*
  • Treatment Outcome
  • Urethra / injuries*
  • Urethra / surgery
  • Urinary Incontinence, Stress / prevention & control
  • Urinary Incontinence, Stress / surgery
  • Urinary Incontinence, Urge