Design: Mesh erosion into the urethra is an uncommon complication of midurethral sling placement. It is even more rare to observe a mesh erosion in the anterior urethra. Surgical management of typical urethral erosions may include a transvaginal or intraurethral approach. In the case of an anterior urethral erosion, a laparoscopic approach may be preferable to access the retropubic space, allowing for removal of mesh from the anterior urethra and additional removal of the retropubic mesh burden.

Setting: This procedure was performed in a hospital setting as outpatient surgery.

Patients or Participants: This is a single case of an anterior urethral mesh erosion after a retropubic midurethral sling placement 8 years earlier. The patient presented with recurrent stress urinary incontinence and urethral pain.

Interventions: This video demonstrates anterior sling mesh excision by a laparoscopic approach. The anterior peritoneum was incised superior to the upper bladder margin, and the retropubic space was entered. The sling mesh was identified and dissected off the pubic bone and the anterior urethra. The urethra was repaired with placement of fine, interrupted sutures.

Measurements and Main Results: Knowledge of anatomy and careful dissection of mesh allowed for safe removal of the anterior urethral mesh erosion. The foley catheter was left in place for 2 weeks and removed after a normal voiding cystogram was demonstrated.

Conclusion: Retropubic midurethral sling mesh erosion into the anterior urethra can be safely removed via a laparoscopic approach. Careful dissection of mesh and achieving hemostasis throughout the procedure are essential steps in this surgical technique. Close attention to avoid excessive tensioning at the time of sling placement is an important consideration in the prevention of urethral mesh erosions.