© 2008 THE AUTHORS 582 JOURNAL COMPILATION © 2 0 0 8 B J U I N T E R N A T I O N A L | 1 0 2 , 5 8 2 – 5 8 5 | doi:10.1111/j.1464-410X.2008.07734.x 2008 The Authors; Journal compilation 2008 BJU International Original Article SAFE AND SIMPLE SOLUTION FOR INTRAVESICAL SLING EROSION AFTER TVT HUWYLER et al. A safe and simple solution for intravesical tension-free vaginal tape erosion: removal by standard transurethral resection Mirjam Huwyler, Johannes Springer*, Thomas M. Kessler and Fiona C. Burkhard Departments of Urology, University of Bern, Bern, Switzerland, and *Hospital of Waldshut, Waldshut, Germany Accepted for publication 8 February 2008 2007; all had standard transurethral electroresection. Their records were reviewed retrospectively to retrieve data on presenting symptoms, diagnostic tests, surgical procedures and outcomes. RESULTS The median (range) interval between the TVT procedure and the onset of symptoms was 17 (1–32) months. The predominant symptoms were painful micturition, recurrent urinary tract infection (UTI), urgency and urge incontinence. There were no complications during surgery. The storage symptoms and UTI resolved completely after removing the eroded mesh in all but one patient. Cystoscopy at 1 month after surgery showed complete healing of the bladder mucosa. CONCLUSION Although TVT erosion into the bladder is rare, persistent symptoms, particularly recurrent UTIs, must raise some suspicion for this condition. Standard transurethral electroresection seems to be a safe, simple, minimally invasive and successful treatment option for TVT removal. KEYWORDS recurrent UTI, tape erosion, tension-free vaginal tape (TVT), transurethral resection Study Type – Therapy (case series) Level of Evidence 4 OBJECTIVE To report our experience with the successful removal of visible tension-free vaginal tape (TVT) by standard transurethral electroresection, as intravesical tape erosion after TVT is a rare complication, and removal can be challenging, with few cases reported. PATIENTS AND METHODS Five patients presenting with TVT erosion into the bladder were treated at our institutions from December 2004 to July INTRODUCTION Since the introduction of the tension-free vaginal tape (TVT) by Ulmsten et al. in 1996 [1] this minimally invasive therapy for stress urinary incontinence (SUI) in women has developed into a widely used and effective procedure, with cure rates of 84–95% [2]. Despite its increasing popularity and apparent simplicity as an ambulatory surgical procedure, there are several reports of specific complications [3–7]. Serious rare complications, e.g. bowel perforation, retropubic haematoma, major vessel and nerve injury, can be associated with the blind passage of the insertion needle [8,9]. Intraoperative bladder perforation is a common event, with an incidence of ≈ 5% [2]. If recognized by cystoscopy and followed by correct trocar placement, bladder perforation usually requires no additional therapy except prolonged catheter drainage. However, the sling procedure with insertion of synthetic material carries the risk of postoperative erosion into the vagina, urethra or bladder. Only a few cases of intravesical tape erosions have been reported [10–15]. The mesh is generally excised (partial or complete) by open surgery. We report on five patients with intravesical TVT erosion several months to years after the initial procedure who had their tapes successfully removed by standard transurethral electroresection (TUR). PATIENTS AND METHODS From December 2004 to July 2007 five patients presented with intravesical erosion of a TVT at the Departments of Urology, University of Bern, Bern, Switzerland (three) and the Hospital of Waldshut, Waldshut, Germany (two). Their records were reviewed retrospectively to retrieve data on presenting symptoms, diagnostic tests, surgical procedures and outcomes. All patients had had a TVT implanted at other centres and were later referred to our institutions. According to the operative reports of the implantation procedure, cystoscopy was used after TVT insertion in all five cases. The diagnostic evaluation included a history, physical examination, urine analysis, transabdominal ultrasonography and cysto-urethroscopy. In one patient, CT was used to exclude concomitant intra-abdominal pathology (Fig. 1). All patients presenting with intravesical TVT erosion during the evaluated period had video-assisted TUR under regional (spinal) anaesthesia. They received perioperative antibiotic prophylaxis, where the first dose was given during surgery and subsequently continued afterward for ≥ 5 days. A rigid BJUI BJU INTERNATIONAL