Department of Urology, Mayo Clinic, Rochester, MN, USA.
Division of Urogynecology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
Int Urogynecol J. 2024 Apr;35(4):921-923. doi: 10.1007/s00192-024-05736-0. Epub 2024 Feb 3.
Intravesical mesh is an uncommon complication following synthetic midurethral sling placement. Management options have included endoscopic techniques such as laser ablation or surgical excision. We present our technique for robotic-assisted excision of intravesical mesh following a retropubic midurethral sling.
The patient is a 66-year-old woman with a remote 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. Robotic excision of the intravesical mesh and stone was performed by entering the space of Retzius, carrying the dissection along the right arm of the retropubic sling, performing two cystotomies to free and remove the mesh, and finally closing the cystotomies in two layers.
The patient was discharged on postoperative day 1. A cystogram prior to catheter removal showed no extravasation and a competent bladder neck. She reported no new stress incontinence and had improvement in overactive bladder symptoms.
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.
膀胱内网片是合成型尿道中段吊带放置后一种罕见的并发症。治疗方法包括内镜技术，如激光消融或手术切除。我们介绍了一种用于经耻骨后尿道中段吊带行机器人辅助膀胱内网片切除的技术。
患者为 66 岁女性，曾有尿道中段吊带激光消融治疗膀胱内网片的病史，且持续存在膀胱内网片症状，伴膀胱颈和右膀胱壁结石。通过进入耻骨后间隙，沿耻骨后吊带的右臂进行解剖，进行两次膀胱造口术以游离并取出网片，最后分两层关闭膀胱造口术，完成机器人辅助膀胱内网片和结石的切除。
患者术后第 1 天出院。在拔除导尿管前进行的膀胱造影显示无外渗和有功能的膀胱颈。患者报告没有新的压力性尿失禁，且膀胱过度活动症状有所改善。
对于存在多处膀胱内网片的患者，经耻骨后尿道中段吊带行合成型尿道中段吊带后机器人辅助膀胱内网片切除是安全可行的。此处报道的处理方面可能有助于处理复杂的膀胱内网片。
