Robotic-Assisted Excision of Intravesical Burch Urethropexy Staples and Mesh.

Abstract

Introduction and hypothesis: 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.

Methods: 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.

Results: 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.

Conclusions: 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.