Polypropylene mesh mid-urethral slings (MUS) are currently the standard of care for the surgical treatment of stress type urinary incontinence. (1) Despite its high efficacy and recommendations for use by international associations, MUS is not without complications and mesh sling exposure occurs in approximately 2% of the cases. The vagina is the most common site of mesh exposure. Sling exposure into the urinary tract, especially the urethra is uncommon with a <1% overall incidence. (2) Endoscopic management and transvaginal excision of the mesh are the treatment options. In this video; we demonstrate transvaginal removal of eroded mesh in a patient with urethral sling exposure.

A 59-year-old woman was referred to our department with voiding difficulty which started after transobturator tape placement in 2011. She experienced recurrent urinary tract infections in the past 3 months. Physical examination revealed tenderness in the anterior vaginal wall, but no vaginal mesh extrusion was detected. Cystourethroscopy detected urethral mesh erosion distal to the bladder neck. Following hydrodissection, inverted U incision was made and the anterior vaginal flap was prepared. Mesh was excised and the urethral defect was repaired primarily using a 5.0 polydioxanone suture. The vaginal defect was closed using 2.0 polyglactin sutures.

The patient was discharged home after an overnight inpatient stay. Foley catheter was removed at postoperative 21. day. No postoperative complication was observed. Urinary obstruction was relieved significantly. Mild stress type urinary incontinence (1 pad per day) occurred after excision of the mid-urethral sling.

Mesh erosion is a common complication of mid-urethral sling procedures. Transvaginal mesh removal is an effective treatment option in patients with sling exposure into the urinary tract. Patients should be informed about the risk of stress urinary incontinence after mesh removal.

Giusto LL, Zahner PM, Goldman HB. Management of the Exposed or Perforated Midurethral Sling". Urol Clin North Am 2019;46:31-40.