V02-03 Robotic-Assisted Intravesical Mesh Excision Following Midurethral Sling

You have accessJournal of UrologyFemale Voiding Dysfunction/ Pelvic Floor Disorders/ Incontinence/ Neuro-Urology (V02)1 May 2024V02-03 Robotic-Assisted Intravesical Mesh Excision Following Midurethral Sling Elizabeth J. Olive and Brian J. Linder Elizabeth J. OliveElizabeth J. Olive and Brian J. LinderBrian J. Linder View All Author Informationhttps://doi.org/10.1097/01.JU.0001008636.33664.3e.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Intravesical mesh is an uncommon complication following synthetic midurethral sling placement. Management options have included endoscopic techniques such as laser ablation, which is less invasive, or surgical excision, which is more invasive but also likely more definitive. We present our technique for robotic-assisted excision of intravesical mesh following a retropubic midurethral sling. METHODS: Our patient is a 66-year-old female with prior history of laser ablation of intraurethral mesh after midurethral sling, and persistent symptomatic intravesical mesh with associated stone at the bladder neck and right bladder wall. After docking the robot, the space of Retzius is entered and mobilized to the pubic symphysis. The right arm of the retropubic sling is identified. Dissection is carried along the sling arm to the bladder wall, where an intentional cystotomy is made to free the intravesical mesh and associated stone from the bladder. Dissection is carried further along the bladder wall, viewing through the first cystotomy to locate the second location of intravesical mesh at the bladder neck. A second cystotomy is made to free the bladder neck component of the mesh and stone. The mesh is removed, and the cystotomies are closed in two layers using 3-0 Stratafix on the mucosal layer, and 2-0 Stratafix on the seromuscular layer. The bladder was retrograde filled with methylene blue and a vaginal exam performed, ensuring a watertight closure and no vaginal injury. RESULTS: The patient discharged on postoperative day 1. Cystogram prior to catheter removal showed adequate bladder healing with no extravasation and competent bladder neck. She reported no new stress incontinence and had improvement in overactive bladder symptoms. CONCLUSIONS: Robotic excision of intravesical mesh after synthetic midurethral sling was safely performed in this patient who had multiple areas of intravesical mesh. Management aspects reported here may be helpful for complex presentations of intravesical mesh. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e100 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Elizabeth J. Olive More articles by this author Brian J. Linder More articles by this author Expand All Advertisement PDF downloadLoading ...