Complications following mid-urethral sling for stress urinary incontinence (SUI) can occur and present with diverse symptoms. Imaging such as MRI and ultrasound are increasingly used in the preoperative work-up to identify mesh-related complications and to assess their anatomical extent, thereby guiding surgical planning. However, accurately defining the full extent of disease may remain challenging. We report a case highlighting these limitations in a clinically significant scenario.

We present the case of a 54-year-old woman with persistent lower urinary tract symptoms, recurrent urinary tract infections, chronic pain and constipation. She had undergone transobturator tape (TOT) placement for SUI followed by a retropubic tape (TVT) due to persistent symptoms. Preoperative evaluation included urethro-cystoscopy, pelvic MRI and translabial ultrasound. Imaging findings suggested an intravesical mesh erosion of the right TVT arm with suspected urethral involvement. Urethro-cystoscopy confirmed a mesh erosion located close to the right ureteral orifice, raising concern for potential ureteral involvement. Based on these findings, a robotic-assisted TVT mesh removal was planned. Patient’s consent was available.

The intervention was performed in lithotomy position, the patient being placed in Trendelenburg at 30 degrees. Intraoperatively, the right ascending branch of the TVT was unexpectedly found to be infiltrating two bowel loops. This extravesical involvement had not been identified on preoperative imaging. After intraoperative consultation with colorectal surgeons, a resection of 20cm of small intestine was performed. A total TVT mesh removal was performed including the intravesical part. The right ureter was not injured. Operation time was 220minutes and the estimated blood loss was below 50ml. Postoperatively, the patient had a nasogastric tube for 6 days until bowel movements resumed. The MonoJ  stent was removed on day 7, while the bladder catheter was kept in place for 14 days.

Despite comprehensive preoperative assessment using multiple imaging modalities, the full extent of mesh-related complications may not always be captured. Unexpected intraoperative findings can significantly alter surgical management and increase procedural complexity and patient burden. Surgeons managing mesh complications should anticipate such scenarios and ensure multidisciplinary readiness.

Continence 19S (2026) 102605
DOI: 10.1016/j.cont.2026.102605