Pfeuti Courtney K, Linder Brian J
Department of OB/Gyn, Division of Urogynecology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
Department of Urology, Mayo Clinic, Rochester, MN, USA.
Int Urogynecol J. 2025 Sep 13. doi: 10.1007/s00192-025-06331-7.
Use of synthetic mesh material in urogynecology for anti-incontinence surgery risks complications such as vaginal exposure and erosion. Although intravesical erosion is rare, management is complex with limited existing guidance, specifically following retropubic urethral suspension procedures.
This is a 78-year-old female patient referred for management of intravesical mesh and staples. Prior surgical history included a retropubic urethral suspension and laparoscopic Burch urethropexy with Prolene mesh. Following years of persistent urinary symptoms, cystoscopy identified intravesical mesh. Imaging revealed multiple tacking device staples in the retropubic space. Robotic-assisted excision of the intravesical mesh and staples was performed. After identification of the retropubic Burch mesh and dissection to the bladder, an intentional cystotomy was made. Circumferential dissection along the mesh permitted complete excision. The cystotomy was closed in two layers and reinforced with a urachal flap.
The patient was discharged on postoperative day one. After two weeks of Foley catheter use, a cystogram showed no extravasation. The patient passed a voiding trial.
Robotic-assisted excision of intravesical mesh from a retropubic urethropexy is safe and feasible. Complete surgical excision helps achieve a tension-free closure and prevent recurrence. Surgical techniques demonstrated here may be helpful for managing such cases of intravesical mesh.
在泌尿妇科抗尿失禁手术中使用合成网片材料存在诸如阴道暴露和侵蚀等并发症风险。尽管膀胱内侵蚀很少见，但管理复杂，现有指导有限，尤其是在耻骨后尿道悬吊手术后。
这是一名78岁女性患者，因膀胱内网片和吻合钉的处理前来就诊。既往手术史包括耻骨后尿道悬吊术和使用普理灵网片的腹腔镜Burch尿道固定术。经过数年持续的泌尿系统症状后，膀胱镜检查发现膀胱内有网片。影像学检查显示耻骨后间隙有多个吻合钉。进行了机器人辅助下膀胱内网片和吻合钉切除术。在识别出耻骨后Burch网片并向膀胱进行解剖后，有意进行了膀胱切开术。沿网片进行环形解剖以实现完全切除。膀胱切开术分两层缝合，并用脐尿管瓣加固。
患者术后第一天出院。使用Foley导尿管两周后，膀胱造影显示无渗漏。患者通过了排尿试验。
机器人辅助下从耻骨后尿道固定术中切除膀胱内网片是安全可行的。完全手术切除有助于实现无张力闭合并防止复发。此处展示的手术技术可能有助于处理此类膀胱内网片病例。
