Extraperitoneal Single-Port Robotic-Assisted Excision of Eroded Bladder Mesh

Objectives: To describe a method for excision of bladder mesh using an extraperitoneal approach with the da Vinci single-port robot.

Methods: A 63-year-old female patient with a history of a retropubic midurethral sling presented with recurrent urinary tract infections (UTIs) and dysuria. She was found to have a mesh erosion within the bladder during a prior cystolitholapaxy of a bladder stone. Preoperative cystoscopy confirmed the presence of eroded bladder mesh and a new bladder stone. The patient underwent a single-port extraperitoneal robotic-assisted excision of the eroded bladder mesh and bladder stone removal. A 4 cm curvilinear incision was made lateral to the umbilicus followed by manual blunt dissection into the space of Retzius. The da Vinci single-port robot was docked through this incision. The space of Retzius was further developed, and the mesh was visualized. The mesh was then dissected off the bladder through blunt and sharp dissection. Intraoperative cystoscopy was used to visualize the bladder stone and identify an appropriate location for cystotomy. After the cystotomy was created, the mesh and calculus were removed through the cystotomy. The bladder was closed in two layers and back-filled with 250 mL of methylene blue diluted in normal saline with no fluid extravasation. Total operative time was 150 minutes. The patient had an uneventful postoperative course and did not require narcotics. On postoperative day 13, a cystogram showed no extravasation, and the foley catheter was removed. The patient has had no recurrent UTIs or bothersome lower urinary tract symptoms since surgery.

Clinical Relevance: Midurethral mesh slings are an excellent long-term treatment option for stress urinary incontinence. However, mesh erosion into the bladder is a potential complication. The single-port robot is well-suited for an extraperitoneal approach for bladder mesh excision without the need for steep Trendelenburg positioning. Excellent safety, wound cosmesis, and postoperative recovery can be achieved with this method.