The correction of pelvic organ prolapses (POP) using transvaginal mesh (TVM) can lead to severe complications such as extrusion, mesh infection and abscesses, chronic pelvic pain, or injuries to adjacent organs.

From the late 1990s to 2010, the use of transvaginal mesh increased exponentially, accounting for up to 30% of POP procedures in many countries. In October 2008 the FDA issued a notification on the complications associated with the urogynecological use of vaginal mesh for POP correction, including pelvic pain, extrusion, erosion, vaginal bleeding, vaginal discharge, and dyspareunia. In 2011, it updated the serious complications associated with these meshes and finally in 2016 reclassified them as class III (high-risk devices). Finally, in 2018 the FDA banned the marketing of transvaginal meshes for correction of the posterior compartment and in 2019 for the anterior compartment. Therefore, between 2018-2019 they will no longer be marketed in the United States. 

The aim of this study is to demonstrate step by step the resolution of mesh extrusion, infection, and abscess formation with left ureteral entrapment through laparoscopic excision of the mesh and ureteral reimplantation.

A 71-year-old woman underwent anterior Prolift mesh and TVT implantation for POP and stress urinary incontinence in 2008. She experienced a 2 cm vaginal extrusion treated in 2010 and a 5 cm extrusion in 2022. Subsequently, she presented with disabling left obturator pelvic pain and continuous purulent transvaginal discharge.

The vaginal hiatus and meatus appeared normal, with purulent discharge evident before examination. The mesh, though taut, showed no clear extrusion but was palpably abnormal at the vaginal vault, surrounded by inflamed, erythematous, and friable mucosa with bleeding on contact.

Upon examination and further studies, was observed mesh extrusion at the vaginal dome with an abscess extending from the vaginal apex to the left obturator muscle through the mesh tract. Additionally, left grade II/IV ureterohydronephrosis due to distal left ureteral entrapment was identified.

Sequential treatment was decided, starting with a left urinary diversion using a double J stent, transvaginal drainage of the abscessed collection, and antibiotic therapy with cefuroxime and metronidazole for 6 weeks. Subsequently, a second laparoscopic stage was performed with liberation and removal of the Prolift mesh from the vaginal apex to the left obturator muscle. During the same procedure, a direct left ureteral reimplantation was performed.

The surgical time was 190 minutes without intraoperative complications and with a blood loss of 100 mL. Postoperative pain was minimal, scoring 2 on the visual analogue scale. The patient was discharged after 48 hours without immediate or delayed postoperative complications.

After three months, the patient is asymptomatic with resolution of chronic pelvic pain, purulent transvaginal discharge, and ureterohydronephrosis. Satisfaction with treatment was measured using the PGI-I questionnaire, with the patient reporting high satisfaction.

Correction of POP with TVMs can be associated with the onset of severe complications. The removal of the mesh through a minimally invasive abdominal approach with simultaneous resolution of complications is a feasible and safe technique.