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Removing a Misplaced Retropubic Midurethral Sling From the Urethra and Bladder Neck Using Ear, Nose, and Throat Instruments

Solomon, Ellen R., MD; Jelovsek, J. Eric, MD, MMEd

doi: 10.1097/AOG.0000000000000568
Contents: Urogynecology: Case Report

BACKGROUND: The retropubic tension-free vaginal tape (TVT) procedure is a common procedure with complications attributed to voiding dysfunction, bladder perforation, and bleeding. We present a case of successful removal of a retropubic midurethral sling from the urethra using a head lamp and a combination of ear, nose, and throat instruments.

CASE: A 63-year-old woman presented to our clinic with the symptom of gross hematuria after having undergone a TVT procedure. On office cystoscopy, the sling was noted to be placed within the urethral mucosa. Removal of the mesh was performed using a nasal speculum, left and right ethmoid scissors, left and right Blakesley graspers, and a head lamp to dissect the mesh directly out of the urethra.

CONCLUSION: The utilization of ear, nose, and throat tools allowed us to resect the intraurethral mesh without necessitating incision of the urethral sphincter.

Excision of a misplaced tension-free vaginal tape was attempted by using a head lamp, nasal speculum, and other ear, nose, and throat instruments.

Center for Urogynecology and Pelvic Reconstructive Surgery, Obstetrics, Gynecology & Women's Health Institute, Cleveland Clinic, Cleveland, Ohio.

Corresponding author: Ellen R. Solomon, MD, Department of Obstetrics and Gynecology, Division of Urogynecology and Pelvic Surgery, Baystate Medical Center Springfield, MA 01199; e-mail:

Presented at the 34rd Annual Scientific American Urogynecologic Society Meeting, October 16–19, 2013, Las Vegas, Nevada.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2015 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.