Large Urethral Calculus Formation on an Transobturator Synthetic Sling in the Urethra

Large Urethral Calculus Formation on an Transobturator Synthetic Sling in the Urethra

S170 Abstracts / Journal of Minimally Invasive Gynecology 19 (2012) S151–S178 551 552 Radiologic Interpretations of Urethral Bulking Agents as Ure...

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S170

Abstracts / Journal of Minimally Invasive Gynecology 19 (2012) S151–S178

551

552

Radiologic Interpretations of Urethral Bulking Agents as Urethral Masses Flora RF,1 Schmitt J,1 Finelli D.2 1Obstetrics and Gynecology, Summa Health System/NEOMED, Akron, Ohio; 2Radiology, Summa Health System/NEOMED, Akron, Ohio

Large Urethral Calculus Formation on an Transobturator Synthetic Sling in the Urethra Flora RF, Rooney C, Schmitt J, Lessick J, Babbitt T. Obstetrics and Gynecology, Summa Health System/NEOMED, Akron, Ohio

Study Objective: Describe radiologic findings of calcium hydroxylapatite used for urethral bulking. Design: A retrospective chart review of two patients where calcium hydroxyapatite injections were incidentally visualized by radiologic means and raised clinical suspicions of cancer. Setting: Urogynecology and reconstructive pelvic surgery practice in community based, university affiliated teaching hospital. Patients: Patients undergoing radiologic imaging with prior urethral bulking treatments for intrinsic sphincteric deficiency. Intervention: Consultation with radiologic colleagues and counseling of patients regarding incidental visualization during subsequent pelvic imaging studies. Review of radiologic images. Measurements and Main Results: Ultrasound and CT descriptions of images are given. Conclusion: Numerous injection materials have been utilized for urethral bulking and ureterovesical reflux. Due to inherent differences between the materials, radiologic appearances will vary. The patients should be advised prior to the procedure that the bulking material might be seen during any future imaging. Radiologist should be educated about these procedures and the imaging findings that may result.

Study Objective: We present a case of a large stone on synthetic mesh in the urethra and how removal was accomplished. The treatment of her incontinence is also described. Design: Retrospective chart review. Setting: Urogynecology and reconstructive pelvic surgery practice in community based, university affiliated teaching hospital. Patients: A 56 yo WF G2P1 with a history of a vaginal hysterectomy and transobturator sling in 2006 was referred 3 years later for continued incontinence, hematuria and dysuria. Examination should urethral hypermobility and bleeding from the urethra. No vaginal mesh erosion was noted. A cystourethroscopy showed a large stone on the sling mesh tranversing through the urethra. Intervention: The patient was brought to surgery. A vaginal incision was made and the sling cut where it entered both sides of the urethra. The stone was too large to pull out through the urethra. The stone was crushed using cystoscopic graspers and scissors. They were removed piecemeal with a stone basket. Once the urethral defects were repaired, a retropubic porcine sling kit was used. Urethral catheter was kept in for 14 days. Measurements and Main Results: Postoperatively, patient was continent until 1 year later. At that time she developed insensible urine loss. Exam showed the sling supporting the urethra well but a positive empty supine stress test was noted. Urodynamics confirmed the presence of ISD. Three calcium hydroxylapatite treatments were performed which resulted in 100% coaptation of the urethra. The patient is continent. Conclusion: The presence of sling mesh in the urethral can occur at the time of insertion due to perforation with the trocar or erosion at a later point. This patient did not have cystoscopy performed at the time of the procedure. This highlights the importance of performing cystoscopy all sling procedures. This is the first reported case of stone formation on a sling and the subsequent treatment. 553 A Case of a Rare Genital Lesion: Genital Porokeratosis Fradinho MW,1 Zimarowski MJ,2 Hur H-C.1 1Obestetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; 2 Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts Study Objective: To review the diagnosis and management of genital porokeratosis. Design: Case report and literature review. Setting: Academic medical center. Patients: Case report. Intervention: Surgical excision. Measurements and Main Results: A 46 year-old presented for annual gynecologic examination without complaints. On examination two