We present a complex case of mesh and tacker extrusion into the bladder following sacrocolpopexy for pelvic organ prolapse. The patient also experienced recurrence of prolapse. This case highlights surgical management involving foreign body removal, hysterectomy, and native tissue repair as a viable alternative to repeated mesh use.

A 53-year-old female underwent sacrocolpopexy in October 2023 for anterior and medial prolapse. In February 2024, she presented with intravesical mesh and tacker extrusion at the bladder fundus and recurrent prolapse. Examination revealed a grade III/IV cystocele and grade II vaginal vault prolapse, without rectocele or incontinence. Initial management included endoscopic removal of bladder foreign bodies. On referral to our center, cystoscopy revealed a 1–2 cm mesh extrusion at 7 o’clock and three submucosal tackers. Imaging showed multiple surgical clips and significant pelvic floor depression.

Surgical intervention was planned with bilateral double J stent placement (left ureter stenosis noted). Intraoperatively, dissection of anterior and posterior mesh arms was performed, followed by removal of multiple vaginal wall tackers. Hysterectomy was carried out with specimen bagging and vaginal extraction. The vaginal vault was closed with continuous suture. Cystorrhaphy and bilateral uterosacral ligament plication were completed. Postoperative imaging and cystoscopy confirmed the absence of remaining foreign bodies.

The patient tolerated the surgery well. Intraoperative findings confirmed foreign body migration and pelvic floor compromise. Complete removal of all exposed and submucosal foreign bodies was achieved. Repair with uterosacral ligament plication restored vaginal support. Postoperative recovery was uneventful.

This case underscores the importance of avoiding metallic fixation materials in soft tissue surgeries due to the risk of migration and extrusion. Robotic or minimally invasive techniques may aid in mesh and foreign body removal. In patients with recurrent prolapse and prior mesh complications, native tissue repair such as uterosacral ligament plication offers a safe and effective alternative.