V12-07 ROBOTIC-ASSISTED TRANSABDOMINAL REMOVAL OF ERODED MID-URETHRAL MESH SLING

Abstract

You have accessJournal of UrologyCME1 Apr 2023V12-07 ROBOTIC-ASSISTED TRANSABDOMINAL REMOVAL OF ERODED MID-URETHRAL MESH SLING Shreeya Popat, Gjanje Smith-Mathus, Alvaro Lucioni, and Una Lee Shreeya PopatShreeya Popat More articles by this author , Gjanje Smith-MathusGjanje Smith-Mathus More articles by this author , Alvaro LucioniAlvaro Lucioni More articles by this author , and Una LeeUna Lee More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003347.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Depending on the indication for excision, there are multiple surgical approaches for the removal of mid-urethral mesh slings: transvaginal, endoscopic, open abdominal, and robotic. In this video, we demonstrate the robotic approach to treat mid-urethral mesh slings that have eroded into the bladder. The robotic approach offers excellent exposure, visualization, and accessibility. Compared to endoscopic approaches, the entire arm of the sling can be removed from the bladder wall, the bladder repaired, and the foreign body thereby completely eliminated from the bladder. Robotic mid-urethral mesh sling excision is ideal in any patient that would be best served by maximal removal of the mesh from the bladder in order to prevent future complications. METHODS: In this video, we display two different cases to show two unique approaches to robotic mid-urethral mesh sling excision depending on the location of the mesh sling erosion: 1) If a retropubic sling is eroded through the anterior bladder, we begin by dropping the bladder and entering the space of Retzius to locate the mesh arm. 2) If the sling is eroded into the posterior bladder, a cystotomy is made on the anterior dome to visualize the posterior bladder wall. RESULTS: Once the mesh is identified, we follow the mesh graft carefully and delicately and dissect it away from surrounding tissues. The dissection is immediately close to the mesh, without fragmenting it, to allow for complete excision. This also allows for protection of adjacent critical structures. The surgical principles and instrument techniques of robotic mesh excision mirror the surgical technique utilized for transvaginal mesh excision. CONCLUSIONS: For treatment of mesh erosion into the bladder, a robotic approach offers excellent visualization, is feasible, and well-tolerated. Compared to fragmenting the mesh using an endoscopic approach, the robotic approach has the advantage of excising the mesh definitively, eliminating the foreign body in the bladder and preventing future recurrences of mesh erosion. Properly selected patients should be offered the robotic approach to mesh excision. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1066 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Shreeya Popat More articles by this author Gjanje Smith-Mathus More articles by this author Alvaro Lucioni More articles by this author Una Lee More articles by this author Expand All Advertisement PDF downloadLoading ...