Robotic assisted laparoscopic total removal of retropubic sling mesh for pelvic pain

Abstract

Retropubic mid-urethral slings (MUS) have been widely used in the surgical management of female stress urinary incontinence. While generally effective, there are cases when MUS removal becomes necessary due to complications or patient discomfort. Removal may be performed through an open or minimally invasive approach. This video demonstrates a robotic approach for the removal of a retropubic MUS, providing a detailed, step-by-step guide. We present a case of a 60-year-old female with bothersome voiding and storage lower urinary symptoms as well as pelvic pain. She was being managed with narcotic pain medication and gabapentin and undergoing pelvic floor physical therapy. Cystoscopy revealed no mesh erosion and urodynamics were consistent with obstruction. Transvaginal partial mesh excision resolved her voiding complaint, but the pain persisted. She elected for complete removal of the mesh. The video demonstrates a successful robotic removal of the retropubic MUS. The patient had resolution of her pain and post-operatively was off all pain medication and back to regular activity highlighting the effectiveness of the robotic approach. Robotic retropubic MUS removal is a valuable technique for managing complications related to MUS. This video offers a comprehensive guide. MUS complications are amenable to multiple surgical approaches, each should be tailored according to the specific patient.