Midurethral sling erosion: NYU Case of the Month, August 2017.

Abstract

Case Presentation A 44-year-old woman presents with a history of recurrent urinary tract infections (UTIs) and stress urinary incontinence (SUI). She reports symptomatic culture-proven UTI about four or five times per year. The UTIs are not associated with anything that the patient can identify and typically respond to antibiotics within 2 to 3 days. In addition, for the past 2 years, she has had significant SUI that occurs when she bends, walks, and moves quickly, as well as with coughing and sneezing, and more strenuous activities. Overall, leakage has progressed in the past 6 months. She also has urgency incontinence one or two times per day, but says that this is not as significant as the SUI. She denies any difficulty emptying her bladder. She has developed new-onset painful intercourse. The history is also significant for a retropubic midurethral sling that was placed for SUI 7 years prior to presentation. The surgical procedure successfully treated her SUI for 5 years, until it recurred 2 years ago. On physical examination, her abdomen is soft and nontender. Pelvic examination reveals healthy vaginal epithelium, with no evidence of exposed mesh, no significant pelvic organ prolapse, and suburethral tenderness that mimics the discomfort that she has with intercourse. She has urethral hypermobility, but stress incontinence is not demonstrated. Her post void residual is zero.