Stress urinary incontinence is a common problem for many women, with a lifetime incidence as great as 50%, and with a significant detrimental effect on their quality of life. Mid-urethral slings are recognised as the gold standard and minimally invasive surgical treatment for stress urinary incontinence. Meta-analysis has shown that both retropubic and transobturator approaches have similar rates of cure in the short and medium term. The retropubic route has a higher rate of overall surgical morbidity, including major visceral and vascular injury and post-operative voiding dysfunction, however it is recognised that the transobturator approach has a higher rate of vaginal perforation. Complications of mid-urethral sling surgery are generally under-reported in the literature, and just as reports on the incidence of vaginal sulcus perforation and mesh exposure vary, so to do the recommendations for the management of these complications.
This oral case presentation will discuss the management of a 48 year old woman with urodynamic proven stress incontinence who was found to have perforation of the lateral vaginal sulcus at the time of her transobturator mid-urethral sling surgery, along with a review of literature regarding the management options for lateral vaginal mesh exposure following mid-urethral sling surgery.