**14. Nerve lesion**

252 Urinary Incontinence

after one year showing recurrence of a stone in the same site of the previous surgery; surgery was performed in the office since the patient refused major surgery. Siegel (2006) reported one case of urethral necrosis and a urethra-vaginal fistula in a 64 year old woman, who needed 3 surgeries; initially TVT mesh fragments were removed and adjacent tissue needed debridement. A urethroplasty was performed as a second surgical procedure and in the third

E Kobashi's (2009) reviewed the different materials and reported the rate of extrusion of

Silicone Monofilament Macro 40-71 TVT Monofilament Macro 2-3 Prolapse repair Monofilament Macro Up to 26 Obtape Monofilament Micro 5.4-16.6 Sparc/Monarc Monofilament Macro 1.7-2.4

Table 5. Synthetic mesh types, Characteristics and Associated Vaginal Extrusion rates.

the TVT is safe and technically possible and solves patient's symptoms.

objective rate than TOT, but the subjective cure is similar for both.

Miraliakbari and Tse (2011) reported the first case of ureteral erosion in a 78 year old woman, the erosion was located in the distal third of the ureter, and the patient was treated

Rouprêt et al (2010) reported resection of the mesh via laparoscopy in 38 women with bladder erosion, vaginal extrusion, bladder obstruction and groin pain. The resection was complete with an operating time of 110 minutes (50 to 240 minute range) all patients reported a decrease in symptoms in a follow up period of 37.9 months (2-80 months range). However, the incontinence recurrence rate is 65.7% (25 patients). Laparoscopic resection of

Novara et al (2010) did a systematic review of pubovaginal sling; retropubic tape (RT) and transobturator tape (TOT) the subjective cure rate is similar among those procedures. Patients who have a TOT inserted have less risk of bladder or vaginal perforation (OR: 2.5 IC: 1.75-3.57; p<0.00001); less risk of hematoma (OR: 2.62; CI: 1.35-5.08; p=0.005) and less risk of urinary tract injury (OR: 1.35; CI: 1.05-1.72; p=0.02). This meta-analysis showed similar results between TVT-O and Monarc. The use of a retropubic tape had a higher

Mendoca et al (2011) report two cases with late urethral erosion with transobturator suburethral mesh (Obtape) the first one diagnosed 1 year after the surgery and the second

With an intestinal lesion, patients refer abdominal pain, peritoneal irritation and sometimes fecal matter leak through the incisions of the kit used (TVT) as was reported by Meschia et al

one, a very late complication, occurring 4 years after the placement of the sling.

Material Fiber type Pore Size Extrusion Rate (%)

surgery a coaptation with an occlusive sling was made to repair the continence.

these. Table 5.

successfully.

**13. Intestinal lesion** 

Geis and Dietl (2002) reported an ilioinguinal nerve lesion after insertion of a TVT, this due to the closeness of the nerve to the sites where the suprapubic incision was made. Rigaud et al (2010) said that pelvic or perineal pain may be a consequence of the obturator nerve or pudendal nerve lesion, a clinical sign that is underestimated.
