Management of iatrogenic foreign bodies of the bladder and urethra following pelvic floor surgery

Objective: Literature regarding the management of iatrogenic foreign body in the bladder and urethra following female pelvic reconstructive surgery, especially mesh erosion, are sparse. We present our recent experience with the removal of iatrogenic foreign bodies from the bladder and urethra and propose a treatment algorithm. Methods: A retrospective review yielded 22 patients with iatrogenic foreign body in the bladder or urethra between 1/1998 and 12/2005. Presenting complaints, cystoscopic findings, operative techniques, and outcomes were reviewed. Results: Source surgery of the iatrogenic foreign bodies included bladder suspension in 9 patients, synthetic sling in 11 patients, abdominal sacrocolpopexy and porcine dermis sling in I patient each. The majority of patients presented with multiple voiding dysfunctions including overactive bladder symptoms (11), incontinence (5), chronic pelvic or urethral pain (7), urinary tract infections (7), obstructive voiding symptoms (5), and gross hematuria (3). Eleven cases were managed endoscopically, 4 using the holmium laser. One patient required subsequent cystorrhaphy. Four patients were managed with urethroplasty, 4 with cystorrhaphy, and the remainder utilizing a combination of techniques. No patients required complex reconstruction with interposition flaps. Conclusions: The diagnosis of iatrogenic foreign bodies in the lower urinary tract requires a high index of suspicion and a low threshold for performing cystoscopy. From this series, we have found that sutures can most often be managed successfully with endoscopic techniques, whereas mesh is best managed with cystorrhaphy and/or urethroplasty. To our knowledge, our series represents the largest number of reported iatrogenic foreign body removals at a single institution.