Over the past decades, midurethral slings (MUS) were the go-to treatment for stress urinary incontinence. In recent years attention is growing towards complications following MUS placement. A large number of complications have been described including bladder perforation, erosion, infection, fistula formation,... 
Historically surgical management for these complications was via abdominal or vaginal route. However, the use of robotic surgery is becoming more widely spread in the treatment of functional and reconstructive urology.

In this video-abstract we present the case of a 68yo woman with complications after MUS implant. She developed erosion of the mesh in de vagina, as well as into the bladder. This resulted in a vesicovaginal fistula. She further had stone formation due to mesh protrusion in the bladder neck/trigone.
This all resulted in severe incontinence, vaginal pain and recurrent urinary tract infections.

A robotic approach was chosen to perform this complicated surgery.
Given the fibrotic changes, a transvesical approach was necessary. The bladder was opened longitudinally after which the stone was removed. The fistula tract was then excised followed by vaginal and vesical closure aided by an omental flap advanced towards the pelvis. 
The procedure was completed in 180 minutes with <100cc blood loss.

The patient was discharged at postoperative day 2 in good overall condition.
She underwent VCUG after 3 weeks which showed no signs of leakage whereafter the indwelling catheter was removed.
Currently 12 months after catheter removal she is free of infections and pain. As expected there is persistent stress urinary incontinence. She is down to 3 pads per day and is comfortable at this moment, she is therefore declining further surgical treatment.

The use of robot-assisted surgery is growing in the field of genitourinary reconstruction. In this case we used robot-assisted surgery to partially remove MUS material and close a vesicovaginal fistula. This approach appeared to be safe and had good clinical outcome.
In selected cases of fistula and/or MUS removal, robotic surgery could provide an alternative to conventional vaginal or abdominal approach.