“Mesh on the Move” Transabdominal Preperitoneal Mesh Erosion into the Urinary Bladder after Laparoscopic Inguinal Hernia Repair

ABSTRACT: Mesh erosion into the urinary bladder is an uncommon but potentially serious late complication of laparoscopic inguinal hernia repair, particularly following transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) approaches. Proposed mechanisms include inadequate peritoneal coverage, excessive mesh fixation, postoperative infection, and chronic inflammatory responses. Clinical presentation is often delayed and nonspecific, leading to diagnostic challenges and prolonged morbidity. We report the case of a 60-year-old male with recently diagnosed hypertension and diabetes mellitus who had undergone laparoscopic mesh repair for left inguinal hernia (details unavailable). He presented with a 9-month history of recurrent burning micturition, lower abdominal pain, and intermittent hematuria. His history was notable for recurrent urinary tract infections over 5 years. Initial evaluation at another centre revealed vesical calculus, left staghorn calculus, and grade 1 prostatomegaly; he underwent transurethral resection of the prostate with cyst lithotripsy. One month later, his urinary symptoms recurred. Investigations at our center showed, on cystoscopy, polypropylene mesh eroding into the anterior bladder wall. Computed tomography (CT) revealed a heterogeneously enhancing lesion in the right anterolateral bladder wall with contrast extravasation. Definitive surgical management involved laparotomy with excision of the involved bladder wall segment containing the mesh, followed by two-layer bladder repair and suprapubic catheter placement. The patient had an uneventful recovery. Intravesical mesh migration should be considered in any patient with persistent urinary symptoms following laparoscopic inguinal hernia repair. A high index of suspicion, combined with early use of CT urography and cystoscopy, facilitates timely diagnosis. Surgical removal of the mesh with bladder wall repair is curative in most cases. This case underscores the importance of meticulous mesh placement and secure peritoneal closure during laparoscopic hernia repairs to minimize such rare but significant complications.