Techniques for total excision of retropubic and transobturator midurethral mesh slings

Abstract

For management of mesh complications relating to full-length midurethral slings, a number of techniques for total excision of mesh have been reported. Surgical excision is invasive due to scarring and anatomical location, requiring effective techniques to avoid complications, such as neurovascular injuries or incomplete excision of mesh when total mesh excision is planned. Detailed surgical technique descriptions of total excision of retropubic midurethral mesh slings and transobturator midurethral mesh slings are presented, including surgical points. In addition, illustrations provide an accurate view of the path of midurethral mesh slings in relation to anatomic considerations. The described techniques have been utilised for the total excision of over 150 midurethral mesh slings, with the authors avoiding any unplanned incomplete mesh excisions. For total excision of retropubic midurethral mesh slings, an open retropubic technique combined with vaginal dissection, allows for effective access to the vaginal, retropubic and subcutaneous potions of the sling, without the addition of risks related to intraperitoneal access with pneumoperitoneum and Trendelenburg positioning. Transobturator midurethral mesh slings can be located and completely excised through vaginal and inner thigh/groin incisions, with good cosmesis.