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Sentetik Mesh Erozyonuna Bağlı Üretrovaginal Fistüle Sekonder Gelişen Üretra Darlığı Tedavisi
Treatment of Urethral Stricture Secondary to Urethral Fistula Due to Synthetic Mesh Erosion
J Reconstr Urol. 2019;9(2):63-7
doi: 10.5336/urology.2019-70336
Article Language: TR
Full Text
ÖZET
Transobturator tape (TOT) öyküsü olan 51 yaşındaki kadın olguya mesh erozyonu nedeni ile mesh eksizyonu uygulanmış. Olgu, zor ve damlama şeklinde idrar yapma şikâyetiyle tarafımıza yönlendirildi. Yapılan fizik muayene ve üretroskopisinde meadan 2 cm proksimalde üretranın komplete yakın oblitere olduğu ve meshin üretrayı eroze ettiği bölgeden vajen anterior duvarına fistülize olduğu görüldü. Spinal anestezi altında dorsal litotomi pozisyonunda vajen ön duvarından eroze meshin proksimal ve distalinde üretraya paralel bir insizyon yapıldı. Taşlaşmış mesh eksize edildi. Yaklaşık 2 cm'lik üretrovajinal fistül alanı ve proksimalinde darlık izlendi. Fistül ve darlık alanı, 18f foley kateter üzerinden vajina lateral duvardan getirilen flep ve martius flep ile onarıldı. İntraoperatif ve postoperatif herhangi bir komplikasyon saptanmadı. Postoperatif 6. Ay takibinde maksimum akım hızı (Q<sub>max</sub>) 25 mL/sn olarak izlendi. Postmiksiyonel rezidü ve inkontinans saptanmadı.
Anahtar Kelimeler: Üretrovajinal fistül; martius flep; üretroplasti; mesh erozyonu
Transobturator tape (TOT) öyküsü olan 51 yaşındaki kadın olguya mesh erozyonu nedeni ile mesh eksizyonu uygulanmış. Olgu, zor ve damlama şeklinde idrar yapma şikâyetiyle tarafımıza yönlendirildi. Yapılan fizik muayene ve üretroskopisinde meadan 2 cm proksimalde üretranın komplete yakın oblitere olduğu ve meshin üretrayı eroze ettiği bölgeden vajen anterior duvarına fistülize olduğu görüldü. Spinal anestezi altında dorsal litotomi pozisyonunda vajen ön duvarından eroze meshin proksimal ve distalinde üretraya paralel bir insizyon yapıldı. Taşlaşmış mesh eksize edildi. Yaklaşık 2 cm'lik üretrovajinal fistül alanı ve proksimalinde darlık izlendi. Fistül ve darlık alanı, 18f foley kateter üzerinden vajina lateral duvardan getirilen flep ve martius flep ile onarıldı. İntraoperatif ve postoperatif herhangi bir komplikasyon saptanmadı. Postoperatif 6. Ay takibinde maksimum akım hızı (Q<sub>max</sub>) 25 mL/sn olarak izlendi. Postmiksiyonel rezidü ve inkontinans saptanmadı.
Anahtar Kelimeler: Üretrovajinal fistül; martius flep; üretroplasti; mesh erozyonu
ABSTRACT
A 51-year-old woman underwent mesh excision due to mesh erosion after transobturator tape (TOT) surgery. She was referred to our hospital because of voiding difficulty and continous dribbling. Physical examination and urethroscopy showed that nearly complete urethral stricture is located 2 cm proximal to external urethral meatus and the fistula at the anterior vaginal wall is located proximal to the stricture. In the dorsal lithotomy position under spinal anesthesia, an incision was made parallel to the urethra in the proximal and distal part of the section where the mesh was erosized from the anterior wall of the vagina. The calcified mesh was excised. Approximately 2 cm urethrovaginal fistula area and proximal stricture was observed. Fistula and stricture was repaired by lateral vaginal wall flap and martius flap via an 18f foley catheter. There were no intraoperative or postoperative complications. In the postoperative 6th month follow-up, maximum flow rate (Q<sub>max</sub>) was 25 mL/s. There was no post-void residual urine and incontinence.
Keywords: Urethrovaginal fistula; martius flap; urethroplasty; mesh erosion
A 51-year-old woman underwent mesh excision due to mesh erosion after transobturator tape (TOT) surgery. She was referred to our hospital because of voiding difficulty and continous dribbling. Physical examination and urethroscopy showed that nearly complete urethral stricture is located 2 cm proximal to external urethral meatus and the fistula at the anterior vaginal wall is located proximal to the stricture. In the dorsal lithotomy position under spinal anesthesia, an incision was made parallel to the urethra in the proximal and distal part of the section where the mesh was erosized from the anterior wall of the vagina. The calcified mesh was excised. Approximately 2 cm urethrovaginal fistula area and proximal stricture was observed. Fistula and stricture was repaired by lateral vaginal wall flap and martius flap via an 18f foley catheter. There were no intraoperative or postoperative complications. In the postoperative 6th month follow-up, maximum flow rate (Q<sub>max</sub>) was 25 mL/s. There was no post-void residual urine and incontinence.
Keywords: Urethrovaginal fistula; martius flap; urethroplasty; mesh erosion
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