Design: Surgical education video and case report

Setting: Secondary care, teaching hospital

Patients or Participants:

A 67yr old female with past surgical history of robotic assisted sacrocolpopexy for advanced stage vaginal vault prolapse presented with incontinence two years after surgery. She was treated with vibegron for overactive bladder with minimal improvement. The pt underwent cystoscopy with an incidental finding of polypropylene sutures eroding into her bladder from the colpopexy. These sutures were used in the prior surgery to attach the anterior and posterior vaginal mesh.

Interventions:

• Cystoscopy to visualize eroded sutures
• Dissection of the vesicovaginal space
• Bladder separated from underlying mesh
• Prolene sutures fully excised
• Anterior vaginal mesh resecured with ethibond suture
• Dermal graft placed between bladder and vagina, secured with ethibond suture
• Cystoscopy performed to confirm sutures were completely excised and bladder had watertight seal with no injuries
• Peritoneum closed overlying the mesh

Measurements and Main Results: Successful robotic-assisted excision of bladder foreign body (eroded suture). Patient was discharged on POD#0 and postoperative period was uneventful. As a precaution, the patient was discharged home with a catheter.

Conclusion: Suture erosion is an infrequent, but important complication and should be considered in patients with refractory overactive bladder after POP surgery. A monofilament non-absorbable suture should not be used under the bladder due to the risk of erosion through the thin bladder wall. Suture erosion into the bladder from an adjacent site can be removed safely and effectively with minimal risk with robotic assisted surgical technique. No entry into the bladder or bladder repair is needed as the suture erosion site is small and detrusor muscle fibers will contract and close the defect.