Management of Eroded Urethral Sling with Calcification into the Bladder
Diagnostic Confirmation
- Cystoscopy is mandatory to visualize the extent of mesh erosion into the bladder and assess the degree of calcification, as recommended by the American Urological Association 1, 2
- Cross-sectional imaging (CT or ultrasound) should be obtained to evaluate the full extent of erosion and rule out abscess formation or sepsis, according to the American Urological Association 1, 3
- Review of the original operative report is necessary to identify sling type, location, and tension applied during placement, as suggested by the American Urological Association 1, 2
Surgical Management Algorithm
- Complete resection of mesh using electrocautery or laser is performed, with a success rate of 77% as first-line therapy for bladder/urethral erosions, as reported by the American Urological Association 1, 3
Critical Pitfalls to Avoid
- Synthetic mesh should not be used for any future incontinence surgery in patients with a history of urethral erosion, as contraindicated by the American Urological Association 4, 5
- Complete removal of eroded calcified mesh is mandatory, and conservative management should not be attempted, as recommended by the American Urological Association 1
- A waiting period of 3-6 months is essential to allow tissue healing and reduce infection risk before considering any replacement incontinence procedure, as suggested by the American Urological Association 1, 3