Surgical removal of TVT mesh is possible, but it is not without risks. There appear to be few surgeons in the UK who are experienced in removal techniques: many surgeons can insert TVT but there seems to be a lack of skilled surgeons with the expertise to perform tape removal. Surgical removal is a much more complex intra-operative procedure compared with TVT placement and should only be carried out by surgeons experienced in mesh removal.
Surgeons may recommend tape ‘division’ (cutting the tape under the urethra) or partial removal of a portion of the tape (eg removing a section of tape under the urethra) as a form of conservative management in the hope that this will resolve problems with voiding, pain, or erosion.
A team in France carried out a study which was published in 2010 and assessed whether full removal is technically possible and what were the results on the patient’s condition. Full mesh removal (resection) was carried out on 38 patients using keyhole surgery (laparoscopic) techniques where possible.
The study concluded that complete laparoscopic resection of TVT is “safe and technically feasible”. It notes that in women who have continuing disabling symptoms after conservative management, doctors must be aware that a complete resection can help resolve the symptoms.
“TVT is still considered the primary surgical choice for female SUI [stress urinary incontinence]. Although TVT offers an effective SUI treatment, it has significant associations with post-operative complications, leading (in specific cases) to a radical surgical management after the failure of first-line treatment. Complete laparoscopic resection of TVT is safe and technically feasible and can help resolve bothersome symptoms. However, women should be warned of the risk of recurrent incontinence.”
Read Article: Laparoscopic Surgical Complete Sling Resection for Tension-Free Vaginal Tape–Related Complications Refractory to First-Line Conservative Management: A Single-Centre Experience, European Urology, Volume 58, issue 2, pages e19-e28, August 2010
View associated video: Complete Laparoscopic Resection Of Tension-Free Vaginal Tape (You Tube)
View a video showing laparoscopic removal of TVT performed by surgeon Natalia Price at the John Radcliffe Hospital, Oxford UK: http://www.youtube.com/watch?v=OqaJ2fRZ3YY
If you are offered mesh removal by a surgeon, make sure that they are experienced and have carried out the procedure before. Ask them how many removals they have undertaken and what the outcomes were. Ask them how they will perform the removal and why - vaginally, abdominally, laparoscopically? Make sure you are fully aware of the risks before you undertake removal surgery.
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