Female stress urinary incontinence (SUI) is highly prevalent. Referal surgical treatment in case of SUI secondary to an uretral hypermobility is the implantation of a synthetic mid uretral sling. 
In some rare cases, those sling can be extruded in the bladder and needs to be removed.

We present the case of a 70-year-old female patient with a history of synthetic mid uretral TOT sling placement in 2017 for stress urinary incontinence. 
Since 2023, she has bladder pain, hematuria and urinary infections.
 The cystoscopy shown an extrusion of the TOT sling, at the bladder neck just above to the right ureteral meatus. 
We decided to perform an explantion of the sling. Considering that the right meatus is just next to the erosion, we planned to do an ureteral reimplantation.

The patient is placed in the Tredelenburg position with her legs spread. 
The ports are positioned and the different arm of the Hugo Medtronic robot are placed. 

The Retzius space is opened and the bladder is freed from it attachments to the anterior abdominal wall. 
The bladder is then opened to the dome and both side of the bladder are attached lateraly with two V-lock stiches. 
We can see the sling extruded in the bladder. It is right above the right ureteral meatus. 
We carefully removed all the sling, using the transvesical approach to remove all the intra vesical portion of the sling. The both arm of the sling are also removed until reaching the obturator formen in both sides. 
After the excision of the mesh, we can see that the right meatus is too close of the bladder opening. 

Considering that was only the meatus, and the rest of the ureter was healthy, we decided to do a side to side ureteral reimplantation. 
The opening of the bladder is closed. 
The right ureter is opened on his distal portion and a JJ stent is placed. 
We opened the bladder on is right side.
To close the ureter on to the bladder opening, we used two running sutures of Quill 4/0.

Wd did a blue injection into the bladder to be sure that the suture are tightened. 

The operative time was 240 minutes with minimal blood loss. There was no postoperative complications. The patient was discharged on postoperative day 2. The urethral catheter was removed at day 15 and the patient resumed spontaneous voiding with no recurrence of SUI and disappearance of bladder pain.

A sling removal is needed if you attest on an intra vesical or uretral extrusion of the mesh. An explantation can be done robotically. This approach offers the possibility of doing in the same time an ureteral reimplantation if needed.

Continence 12S (2024) 101528
DOI: 10.1016/j.cont.2024.101528