Recurrence and Treatment Outcomes After Excision of Intravesical Exposed Midurethral Sling Mesh

Objectives: The objective of this review was to determine the recurrence rate of exposed intravesical mesh midurethral sling following both open and transurethral excisional approaches at a single tertiary care center. Secondarily, patient presenting symptoms and subjective cure were evaluated.

Methods: This was a retrospective case series of female patients who underwent operative excision of a mesh midurethral sling from the bladder between 2009 and 2022 at a single tertiary care center. Demographic data, presenting symptoms, cystoscopic findings, intraoperative complications and recurrence or persistence of mesh in the bladder were extracted via chart review.

Results: Eleven female patients underwent operative excision of exposed bladder mesh from previously placed midurethral slings. The average patient age was 65.7 years (range 43-80) with an average BMI of 32.61 kg/m² (range 23.41-47.83 kg/m²). There were 6 current daily tobacco smokers, 2 former smokers and 3 never smokers. There were 9 retropubic and 3 transobturator slings (one patient had both sling types). Presenting symptoms included pain/urgency (82%), recurrent UTIs (64%) and hematuria (27%). One excision was performed through an abdominal incision and included partial cystectomy, while 10 excisions were performed transurethrally with or without laparoscopic assistance. The primary outcome, recurrence of mesh exposure in the bladder, was identified in 5 of the 8 patients (63%) who completed cystoscopy surveillance after a minimally invasive approach, with average surveillance duration of 74 months (0-172 months). Among those with recurrence, 10 additional transurethral excisions were performed for recurrent mesh and one open excision was performed due to the development of a retropubic abscess. All patients with successful initial transurethral excision (3) and an additional three patients had subjective resolution or improvement of their presenting symptoms after their initial operative excision.

Conclusions: Late diagnosis of exposed midurethral sling mesh in the bladder is rare and occurs following either retropubic or transobturator approaches. The decision of surgical approach for bladder exposure of midurethral sling mesh should be a patient-centered decision, including the benefits of minimally invasive surgery weighed against the risk of recurrent or persistent bladder midurethral sling mesh exposure.