Surgical Approach to Urethral Diverticulum and Urethrovaginal Fistula With Mesh Erosion.

Int Urogynecol J

Department of Obstetrics and Gynecology, Division of Urogynecology, Cooper University Healthcare, Camden, NJ, USA.

Published: June 2024

AI Article Synopsis

  • The video presents a complex surgical case involving a 58-year-old woman diagnosed with a urethral diverticulum, urethrovaginal fistula, and mesh erosion, related to her past surgeries for stress urinary incontinence.
  • Detailed intraoperative techniques are shown, including the careful resection of the affected areas and the use of specialized tools, all while ensuring healthy tissue is preserved for closure.
  • The surgery was successful with no complications, and the findings suggest that the combination of the diverticulum, fistula, and mesh erosion is uncommon and may be linked to the patient's previous mesh procedures.

Article Abstract

Introduction And Hypothesis: This video illustrates a rare surgical case involving a urethral diverticulum, urethrovaginal fistula, and mesh erosion.

Methods: We present a 58-year-old patient attending a tertiary care center with a suspected urethrovaginal fistula. Her concerns included stress urinary incontinence (SUI), recurrent urinary tract infection, and vaginal pain. The surgical history was notable for the placement of two different mesh slings during the same procedure to treat SUI. Preoperative evaluation and findings are illustrated in detail. The video uses a high-definition surgical camera to emphasize the initial intraoperative evaluation with localization of the fistula and diverticulum. We then demonstrate the approach to the dissection with the goal of ensuring complete resection of the diverticulum, fistula, and mesh, while preserving healthy tissue for subsequent closure. The utilization of unique and specialized tools for each portion of the procedure is also illustrated. A layered vaginal closure, including a Martius flap, is created to prevent recurrence.

Results: The surgery was accomplished without complications.

Conclusions: To our knowledge, concomitant findings of a urethral diverticulum, urethrovaginal fistula, and mesh erosion are unique in the literature. We postulate that this triad could have resulted from the mesh burden in this particular patient.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11245446PMC
http://dx.doi.org/10.1007/s00192-024-05787-3DOI Listing

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