A technique of laparoscopic mesh excision from the bladder after sacrocolpopexy

Several series have demonstrated the feasibility, safety, and efficacy of laparoscopic sacrocolpopexy. Nonetheless, complications such as mesh erosion into the bladder can occur years after primary surgery, with accidental cystotomy during the primary operation appearing to be a risk factor for later mesh erosion. Over the last 10 years, we have treated 7 patients with mesh erosion into the bladder after laparoscopic sacrocolpopexy using a technique of transvesical laparoscopic partial excision of the eroded mesh. None of these 7 patients developed recurrent erosions, fistulas, or recurrent prolapse. The video demonstrates laparoscopic excision of intravesical mesh in a patient 5 years after laparoscopic sacrocolpopexy. Key steps are opening the bladder to grasp and dissect the eroded mesh; partial resection of the mesh with formation of a bladder flap; and closure of the bladder. Laparoscopy appears to be a useful tool for the treatment of this problem. Because many urogynecology units around the world have now begun to perform laparoscopic sacrocolpopexy, urogynecologists should be aware of these complications and how to treat them. The video is intended to help and encourage centers performing laparoscopic transvesical excision of mesh eroded into the bladder after sacrocolpopexy.