Robotic suburethral sling removal and bilateral pudendal nerve release: resolution of chronic pelvic pain and recurrent urinary tract infections

Saavedra Centeno M1, Vázquez L2, Velasco Balanza C1, Pelari Mici L1, Márquez Güemez C1, Pérez Pérez M1, Casado Varela J1, San José Manso L1, López-Fando Lavalle L3

Research Type

Clinical

Abstract Category

Female Lower Urinary Tract Symptoms (LUTS) / Voiding Dysfunction

Abstract 120
Surgical Videos 2 - Bowel, Urogynaecology Reconstruction and Neuromodulation
Scientific Podium Video Session 14
Thursday 8th October 2026
11:22 - 11:30
Parallel Hall 3
0.4 Brussels / 0.5 Paris
Capacity: 356
Voiding Dysfunction Surgery Pain, Pelvic/Perineal Genital Reconstruction Infection, Urinary Tract
1. Hospital Universitario de la Princesa, 2. Clinica UROLF, 3. Hospital Universitario de la Princesa, Clínica UROLF
Presenter
L

Lira Pelari Mici
Hospital Universitario de la Princesa

Links

Abstract

Introduction
Late complications of suburethral slings include chronic pelvic pain and recurrent urinary tract infections (UTIs). Pudendal nerve involvement is an underrecognized cause, particularly in patients with prior complex pelvic surgery.
Design
A 47-year-old woman with a history of hypothyroidism, hysterectomy, and prior colposacropexy (Upsylon) with transobturator tape (TOT) placement complicated by right ureteral injury (2019), requiring ureteral reimplantation (2020), was referred for a second opinion due to recurrent UTIs.
She presented with suprapubic pain radiating to the lower limbs and eight UTIs in the previous year. Physical examination revealed right paraurethral tenderness without mesh extrusion. Cystoscopy and urodynamic evaluation were normal. Voiding cystourethrogram showed minimal right-sided vesicoureteral reflux. CT scan confirmed right ureteral reimplantation and a left ureterocele. Neurophysiological findings were consistent with bilateral pudendal nerve entrapment, predominantly on the right side.
Results
Fixation of the sigmoid colon to the abdominal wall. Anterior peritoneal incision. Right paraurethral dissection with identification of the prior mesh. The right pudendal nerve was identified under intraoperative neuromonitoring and the right mesh arm was transected. Identification of the left mesh arm and ipsilateral pudendal nerve, followed by dissection and transection. Complete mesh removal was achieved. Hemostasis and peritoneal closure were performed.

Postoperative course was uneventful. Catheter was removed on postoperative day 7. The patient reported significant improvement in pain. Uroflowmetry showed Qmax 30 mL/s, voided volume 613 mL, and postvoid residual 13 mL. No UTIs have occurred since surgery. Ongoing follow-up with Gynecology.
Conclusion
Robotic sling removal combined with pudendal nerve release is an effective option in selected patients with chronic pelvic pain and recurrent UTIs following mesh surgery. Identification of the neuropathic component is essential for optimal outcomes.
Disclosures
Funding None Clinical Trial No Subjects Human Ethics not Req'd Surgery Helsinki Yes Informed Consent Yes AI For simple textual assistance in writing the abstract manuscript
Citation

Continence 19S (2026) 102597
DOI: 10.1016/j.cont.2026.102597

20/08/2026 15:46:21