Top

International Urogynecology Journal

Published in:

01-01-2016 | Original Article

Martius graft for TOT extrusion: a case series

Authors: Alexander Mortimer, Aethele Khunda, Paul Ballard

Published in: International Urogynecology Journal | Issue 1/2016

Abstract

Introduction

The management of mid-urethral tape extrusion is inconsistent. We believe that we present here the first case series detailing the use of the Martius graft for trans-obturator tape (TOT) extrusion.

Methods

Five women had a Martius graft for TOT extrusion. Data were obtained retrospectively from case notes and a review postoperatively to investigate the results in the short and intermediate term.

Results

All extrusions were greater than 1 cm in diameter and situated between the midline and the lateral vaginal sulcus. In 3 women the tape extrusion was discovered at 6–12 weeks postoperatively and 2 presented with symptoms again after 12 months. Following the Martius graft, there was no ipsilateral recurrence of tape extrusion or exposure. Postoperatively, 2 women received oral antibiotics. Two women developed de novo sexual problems, which had resolved at follow-up.

Conclusions

It is promising that all the tape extrusions were successfully treated with a Martius Graft, thus preserving tape function. There was a high incidence of minor complications initially, but there was minimal long-term morbidity and no cosmetic dissatisfaction. We believe that testing this proposition in a larger case series will provide better evidence.

Haylen BT, Freeman RM, Swift SE, Cosson M, Davila GW, Deprest J, Dwyer PL, Fatton B, Kocjancic E, Lee J, Maher C, Petri E, Rizk DE, Sand PK, Schaer GN, Webb R (2011) An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint terminology and classification of the complications related directly to the insertion of prostheses (meshes, implants, tapes) and grafts in female pelvic floor surgery. Neurourol Urodyn 30(1):2–12PubMedCrossRef

Kobashi KC, Govier FE (2003) Management of vaginal erosion of polypropylene mesh slings. J Urol 169(6):2242–2243PubMedCrossRef

Kuhn A, Eggeman C, Burkhard F, Mueller MD (2009) Correction of erosion after suburethral sling insertion for stress incontinence: results and related sexual function. Eur Urol 56(2):371–376PubMedCrossRef

Price N, Jackson S (2010) Management of vaginal mesh erosion following the tension free vaginal tape procedure: five years’ experience at a UK tertiary referral centre. Presented at the meeting of ICS/IUGA, Toronto, Canada. Abstract retrieved from http://www.ics.org/Abstracts/Publish/105/000763.pdf

Basu M, Gorti M, Onifade R, Franco A, Fynes M, Doumouchtsis S (2013) Continence outcomes following partial excision of vaginal mesh exposure after mid-urethral tape insertion. Eur J Obstet Gynaecol Reprod Biol 167(1):114–117CrossRef

Al-Wadi K, Al-Badr A (2009) Martius graft for the management of tension-free vaginal tape vaginal erosion. Obstet Gynaecol 114(2):489–491CrossRef

Sajjadi SG, Hortvath OP, Kalmar K (2012) Martius flap: historical and anatomical considerations. Eur J Plast Surg 35(10):711–716CrossRef

Matte A, Delorme E (2012) [The Martius flap in stress urinary incontinence treated by sub-urethral sling]. Prog Urol 22(12):725–730PubMedCrossRef

Pitel S, Lefevre JH, Parc Y, Chafai N, Shields C, Tiret E (2011) Martius advancement flap for low rectovaginal fistula: short- and long-term results. Colorectal Dis 13:112–115CrossRef

10.

Carey JM, Chon JK, Leach GE (2003) Urethrolysis with Martius labial fat pad graft for iatrogenic bladder outflow obstruction. Urology 61:21–25PubMedCrossRef

11.

Petrou SP, Jones J, Parra RO (2002) Martius flap harvest site: patient self-perception. J Urol 167:2098–2099PubMedCrossRef

Title: Martius graft for TOT extrusion: a case series
Authors: Alexander Mortimer
Aethele Khunda
Paul Ballard
Publication date: 01-01-2016
Publisher: Springer London
Published in: International Urogynecology Journal / Issue 1/2016
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-015-2799-1

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Martius graft for TOT extrusion: a case series

Abstract

Introduction

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2016

MRI suggests increased tonicity of the levator ani in women with interstitial cystitis/bladder pain syndrome

Laparoscopic supracervical hysterectomy with transcervical morcellation and sacrocervicopexy for the treatment of uterine prolapse

Assessment of urethral vascularity using 2D colour Doppler high-frequency endovaginal ultrasonography in women treated for symptomatic stress urinary incontinence: 1-year prospective follow-up study

Urogynecology digest

Comparison of the functionality of pelvic floor muscles in women who practice the Pilates method and sedentary women: a pilot study

Indications and risk factors for midurethral sling revision