Related Experiment Video
Updated: Aug 7, 2025
A Novel Surgical Technique in a Sheep Model for Suburethral Graft Implantation
Published on: June 20, 2025
Vaginal and laparoscopic sub-urethral sling explantation
Virginie Collin-Bund1,2, Victor Gabriele3, Chris Minella3
1Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, 67091, Strasbourg, France. virginie.bund@chru-strasbourg.fr.
Introduction And Hypothesis:
The objective was to describe the different laparoscopic and vaginal steps of sub-urethral infected mesh explantation as well as an unexpected and unusual complication: a sub-mucosal calcification on the sub-urethral segment of the sling that was not infiltrating the urethra.
Methods:
This was carried out at our University Teaching Hospital of Strasbourg.
Results:
We show the complete removal of an infected retropubic sling in a patient who had already undergone three previous surgeries without resolution of symptoms. This is a difficult case requiring a laparoscopic approach of the space of Retzius, which has been less familiar to surgeons since the advent of the midurethral sling. We show how to approach this space in an inflammatory environment by specifying its anatomical limits. Moreover, a great deal can be learned from the occurrence of an infectious complication after the surgery and the presence of a large calcification on the prosthesis. In this context, we advise a systematic antibiotic treatment to avoid this kind of complication.
Conclusions:
Knowing the guidelines and the different surgical steps will help urogynecological surgeons to perform similar procedures in patients requiring removal of retropubic slings for complications such as infection and pain, where conservative management has not been successful. These cases must be discussed in a multidisciplinary meeting, as recommended by the French National Authority for Health, and managed in an expert establishment.
Insights
This study details laparoscopic and vaginal removal of infected sub-urethral slings. It highlights managing unusual complications like calcification and advises antibiotic use to prevent infection after mesh surgery.
Area of Science:
- Urogynecology
- Minimally Invasive Surgery
- Surgical Complications
Background:
- Sub-urethral slings are used for stress urinary incontinence.
- Infection and pain are potential complications requiring mesh explantation.
- Previous surgeries may complicate explantation procedures.
Purpose of the Study:
- To describe laparoscopic and vaginal techniques for infected sub-urethral mesh explantation.
- To report an unusual complication of sub-mucosal calcification of the sling.
- To provide guidance for managing complex mesh removal cases.
Main Methods:
- Laparoscopic approach to the space of Retzius for infected retropubic sling removal.
- Vaginal surgical steps for explantation.
- Management of a case with prior unsuccessful surgeries.
Main Results:
- Successful complete removal of an infected retropubic sling was achieved laparoscopically.
- An unusual sub-mucosal calcification on the sling, not infiltrating the urethra, was identified.
- The case involved a patient with a history of three prior surgeries for unresolved symptoms.
Conclusions:
- Laparoscopic and vaginal techniques are crucial for infected mesh explantation.
- Awareness of potential complications like calcification is important.
- Multidisciplinary discussion and management in expert centers are recommended for complex cases.
