Conservative management of intravesical erosion of a synthetic mid-urethral sling for the treatment of stress urinary incontinence, based on patient preference: A case report

Crown Copyright © 2022. Background: Intravesical mesh erosion is an uncommon late complication of placement of a synthetic mid-urethral sling (MUS) for the treatment of stress urinary incontinence, and only a few cases have been reported. Optimal management remains controversial, though there is a tendency toward surgical removal through a variety of routes. However, surgical removal comes with its own risks and is not necessarily associated with an improvement in symptoms. We, herein present the first case of a conservatively managed intravesical mesh erosion following MUS placement. Case: Nine years after insertion of a tension-free vaginal tape (TVT), a patient presented with persistent lower abdominal pain and dysuria. Flexible cystoscopy demonstrated an erosion of the tape through the bladder wall. The patient declined surgical intervention at the time. Therefore, she was commenced on regular methenamine hippurate and vaginal oestrogen, and kept under surveillance with regular cystoscopies. Her symptoms responded to this treatment and 6 years later remained well controlled on this regime. Conclusion: This case demonstrates that conservative management may be a safe and appropriate option for patients who decline surgical excision of mesh erosion.No funding from an external source supported the publication of this case report

Long term safety outcomes and continuation rates of repeated Intravesical Botulinum Toxin A injections for Detrusor Overactivity: 16 year’s experience of a Tertiary Centre in the UK

Introduction:: Overactive bladder (OAB) affects 27% of women in the UK with an adverse impact on quality of life. Medical treatment with anticholinergics has a high discontinuation rate due to side effects. OnabotulinumtoxinA (BOTOX ®) is an established treatment for refractory OAB, although there are little published data regarding safety with long term use. Objective:: To report the long-term safety and continuation rates of intravesical Botox for OAB. Methods:: This was a retrospective cohort study of patients treated with botulinum toxin A for OAB in a tertiary centre from 2007–2023. Data were collected retrospectively from medical records. Results:: 132 patients were identified, with a total of 574 episodes of intravesical Botox. Mean age at first treatment was 55 years. After 1st Botox treatment, 21% of patients developed urinary tract infections. Clean intermittent self-catheterisation (CISC) was performed in 33% of patients, 5% of whom were performing CISC prior to treatment. The range of number of Botox treatments per patient was 1–18; 74% had more than one treatment. 52% of patients were lost to follow-up and 30% are ongoing patients. Recurrent UTIs developed in 23%. Conclusion:: Repeated Botox injections appear to be a safe form of treatment for refractory OAB. Long term complications include recurrent UTIs, which affects 1 in 4 women, and voiding dysfunction, which affects 1 in 5. Only 1 in 3 women continue long term Botox treatment