Larner College of Medicine, University of Vermont, Burlington, VT, USA.
Department of Urology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Int Urogynecol J. 2024 Aug;35(8):1719-1721. doi: 10.1007/s00192-024-05871-8. Epub 2024 Jul 13.
We describe the surgical management of intravesical mesh perforation following transvaginal mesh surgery for pelvic organ prolapse.
A 73-year-old woman presented with intravesical mesh perforation 17 years following transvaginal mesh-based prolapse repair at an outside hospital. The patient presented with intermittent hematuria and recurrent urinary tract infections. Cystoscopy demonstrated an approximately 3-cm area of intravesical mesh with associated stone spanning from the bladder neck through the left trigone and ureteral orifice. A robotic-assisted transvesical mesh excision and left ureteroneocystostomy was carried out. Robotic-assisted repair was performed transvesically via transverse bladder dome cystotomy. Dissection was carried out circumferentially around the mesh in the vesicovaginal plane, including a 1-cm margin of healthy tissue. The eroded mesh was excised, and the vaginal wall and bladder were closed with running absorbable sutures. Given the location of the mesh excision and repair, a left ureteral reimplantation was performed. The transverse cystotomy was closed and retrograde bladder filling with methylene blue-stained saline confirmed watertight repairs, with no vaginal extravasation.
The patient was discharged the following morning and had an uneventful recovery, including transurethral indwelling catheter removal at 2 weeks after CT cystogram and subsequent ureteral stent removal at 6 weeks postoperatively. At 2-month follow-up she had no new urinary symptoms or obstruction of the ureteral reimplantation on renal ultrasound.
A robotic-assisted approach is a feasible option for managing transvaginal prolapse mesh perforation into the bladder. Pelvic surgeons must be well equipped to handle transvaginal mesh complications in a patient-specific manner.
我们描述了经阴道网片修补术后膀胱内网片穿孔的手术处理方法。
一位 73 岁的女性在外地医院接受经阴道网片修补术治疗盆腔器官脱垂 17 年后出现膀胱内网片穿孔。患者表现为间歇性血尿和复发性尿路感染。膀胱镜检查显示膀胱颈至左侧三角区和输尿管口有一个约 3 厘米大小的膀胱内网片穿孔，伴有结石。行机器人辅助经膀胱网片切除和左输尿管膀胱再吻合术。经膀胱顶横行切开行机器人辅助修补。在膀胱阴道平面上环绕网片进行解剖，包括 1 厘米宽的健康组织边缘。切除侵蚀的网片，用可吸收缝线连续缝合阴道壁和膀胱。考虑到网片切除和修复的位置，行左输尿管再植入术。横向膀胱造口关闭，逆行膀胱充盈蓝色亚甲蓝染色盐水证实无渗漏修复，无阴道外渗。
患者次日早晨出院，恢复顺利，包括 2 周后经 CT 膀胱造影拔除经尿道留置导尿管和 6 周后拔除输尿管支架。2 个月随访时，肾超声检查未见新的尿症状或输尿管再植入梗阻。
机器人辅助方法是处理经阴道脱垂网片穿孔入膀胱的可行选择。盆腔外科医生必须具备处理经阴道网片并发症的能力，以个体化的方式处理。
