We present a case of a 57-year-old woman who sustained bladder erosion with extension to the left ureter after a mesh-augmented recurrent cystocele repair. The persistence of the eroding mesh eventually necessitated a partial cystectomy and distal left ureterectomy, using a Boari flap technique.
The use of surgical material for augmentation of pelvic organ prolapse (POP) repair has become increasingly popular in recent years.
Although long-term positive results have been described, complications such as vaginal, bladder and rectal erosions, fistulae, Intensive Treatment Unit admission, blood transfusion, and dyspareunia have been published, raising the question of the safety of this new technique of prolapse repair.
Case Report
A 57 year old woman, with 2 previous forceps deliveries, underwent a type I polypropylene mesh (Prolift; Ethicon, Somerville, NJ) repair of a recurrent grade II cystocele. The patient underwent an abdominal hysterectomy in 1982 for uterine leiomyomas and an anterior colporrhaphy in 2004. She was not a smoker and did not suffer from any medical condition.
The patient was fully counseled and consented prior to surgery and the anterior Prolift was performed using the standard technique as described in the literature in a general district hospital. During the insertion of the trocar needles through the obturator fossa, a small perforation of the bladder was clinically suspected, which was immediately confirmed by cystoscopy. The trocar was subsequently removed and the mesh reapplied with success. At the end of the procedure, a cystoscopy confirmed the bladder integrity. A 16 Ch indwelling bladder catheter was left in situ for 72 hours after the surgery.
Two weeks later the patient presented with severe vaginal pain, frequency, nocturia, urgency, urinary incontinence, and buttock pain. In view of her persistent lower urinary tract symptoms (LUTS), the patient was referred to our tertiary urogynecology unit. A full clinical evaluation including urethrocystoscopy was performed. A protrusion of the mesh through the bladder base was seen. This was excised endoscopically and the patient reported a significant improvement in urgency and buttock pain ( Figure 1 ).
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