Erosion of mesh into the urethra is an uncommon complication of mid-urethral sling placement. Often surgical management is necessary, requiring not only removal of the affected mesh but also urethral repair or reconstruction. A suprameatal approach to excision can be used to limit the risk of postoperative urethrovaginal fistula formation.

A 67-year-old female with a history of two incontinence procedures, including a synthetic mesh sling, presented with dysuria, mixed urinary incontinence, and urinary urgency. Of note, she was a long-term daily smoker with Type 2 diabetes mellitus. She was found by in-office cystoscopy to have a urethral mesh erosion and subsequently underwent mesh excision and urethroplasty via a suprameatal vaginal approach.

Intraoperative findings revealed retropubic sling with ventral urethral mesh erosion, approximately 3 centimeters proximal to the urethral meatus, with no vaginal or bladder mesh exposure. The patient’s recovery was uncomplicated, with normal CT urogram following catheter removal 3 weeks postoperatively. She had complete resolution of her dysuria. She did experience persistent mixed incontinence symptoms, but deferred additional medical or procedural therapies.

A suprameatal approach to excision of urethral mesh erosion is preferred to limit the rate of fistula formation and recurrent stress incontinence. The ventral urethral attachments can be untethered from the pubic bone allowing for direct access to the mobilized urethra for mesh excision and urethral reconstruction.

Continence 19S (2026) 102741
DOI: 10.1016/j.cont.2026.102741