Management of the Exposed or Perforated Midurethral Sling

The synthetic midurethral sling has become the gold standard for treatment of stress urinary incontinence since its introduction more than 20 years ago. With its utilization, the incidence of mesh-related complications has also increased. Mesh exposure and perforation are 2 common mesh complication scenarios that pelvic floor surgeons should be prepared to treat. This article highlights preoperative, perioperative, and postoperative factors to minimize the chance of vaginal wall mesh exposure or perforation of mesh into the lower urinary tract. It also summarizes common presenting symptoms, suggested evaluation and a range of treatment options.