Category: Robotic Surgery: Lower Tract - Benign

Introduction & Objective : A 49 year old female presented to the office initially with complaints of excruciating pelvic pain and frequent urinary tract infections.  She had been prescribed many courses of antibiotics and pain medications without relief.  Her pain began 4 years prior to presentation immediately after having a retropubic midurethral sling placed during her hysterectomy.  On exam, she had exquisite tenderness to palpation over her pubic symphysis.  Cystoscopy in the office revealed a large stone adherent to her bladder dome as well as visible mesh within the urethra.  Presented here is an interesting case of excision of perforating mesh using a combined robotic-assisted laparoscopic and transvaginal approach.

Methods : The Da Vinci Xi robotic platform was used to expose both retropubic arms of the sling as well as the bladder stone with associated sling perforation.  A transvaginal approach with urethrolysis was used to complete the resection of the synthetic midurethral sling.

Results : A foley catheter was placed postoperatively and the patient was discharged on postoperative day one.  At her three week follow-up visit, she noted that her pain was completely resolved since surgery.  The catheter was removed at this visit and she was able to void spontaneously without leakage.

Conclusions :

A synthetic midurethral sling perforated both the bladder and the urethra in the case of this patient.  Using a combined approach of robotic as well as transvaginal mesh excision, we achieved resolution of symptoms for our patient with a one day hospital stay and no complications.

Author(s)

• AC

  Amanda Carter

  – Resident, University of TN College of Medicine Erlanger Health System Dept. of Urology, Chattanooga, Tennessee

Presenting Author(s)

• 

  Nathan Jung

  – Resident, University of TN College of Medicine Erlanger Health System Dept. of Urology, Chattanooga, Tennessee

Author(s)

• AS

  Amar Singh

  – faculty, University of TN College of Medicine Erlanger Health System Dept. of Urology, Chattanooga, Tennessee
• HO

  Henry Okafor

  – faculty, University of TN College of Medicine Erlanger Health System Dept. of Urology, Chattanooga, Tennessee