Antegrade endoscopic removal of retained urethral sling mesh in the bladder

The midurethral sling has emerged as an effective, minimally invasive treatment for patients with stress urinary incontinence. Bladder penetration is a known complication that, if unrecognized, may result in retained intravesical mesh. This rare complication can cause patient discomfort as well as become a nidus for infection and bladder calculi. Because of the technique of sling passage, the site of retained sling material is often along the anterior bladder wall, making evaluation and treatment via traditional retrograde cystoscopy prohibitively difficult. We describe a novel and minimally invasive method to remove the sling material using antegrade access into the bladder in conjunction with holmium laser vaporization. In our series of six patients in whom retrograde cystoscopic treatment had failed, all were successfully treated with antegrade cystoscopy and reported improved urinary symptoms. This new technique provides a simple, minimally invasive, and effective method for removal of exposed sling mesh.