Tension-free vaginal tapes (TVT, TVTO) and colposuspension are established andeffective procedures for treating stress urinary incontinence. However, severe and complexcomplications can occur, necessitating individualized surgical management. These include voidingdysfunction with or without residual urine, recurrent urinary tract infections, mesh erosions into thevagina, urethra, bladder or bowel, chronic pelvic pain, and fistula formation. Conventional techniquesof partial vaginal mesh removal have not consistently resolved symptoms and may lead to recurrenturethral injury, chronic pain, or fistulation. To present a systematic management algorithm for complications following TVT/TVTO or colposuspension and to introduce the „MERVAT technique“ (Minimally Invasive ExtraperitonealRetropubic Vaginal-Assisted Technique) for complete removal of suburethral mesh, retropubic slingarms, or suture material.

Depending on symptom pattern and type of complication, partial or complete meshexplantation was performed. Vaginal mesh excision was considered sufficient for isolated suburethralerosions, whereas complete removal of retropubic components is not achievable via the vaginal routealone. The MERVAT technique enables safe explantation of retropubic mesh arms through a minimallyinvasive, extraperitoneal approach while preserving adjacent structures.

A total of 74 patients (age 28–84 years, mean 57.5) treated between 01/2017 and 05/2025were included. Implant dwell time ranged from 5 months to 33 years (mean 5.3). Explantedmaterials included: Dynamesh-SIS 7, TVA/SensiTVT 5, Serasis PP/PA 17, Gyncare TVT/TVTO 29,TVT/TVTO polypropylene (manufacturer unknown) 5, Advantage 4, Zoedler 1, Monarc 1; one self-constructed suburethral–retropubic mesh anchored with Prolene to Cooper’s ligament; and fourcolposuspensions. The MERVAT technique achieved high success rates regarding completeexplantation and symptom reduction, with low morbidity and short recovery time. Operating timeranged from 48–304 minutes (mean 122).

The MERVAT technique allows safe, complete removal of retropubic slings and mesh, even in complex or long-standing cases. It overcomes the limitations of conventional vaginal removal, achieving symptom relief with low morbidity and short recovery. These results highlight MERVAT as an effective approach for managing severe mesh-related complications.

The MERVAT technique is a safe and effective method for managing complexcomplications after TVT/TVTO procedures and for extraperitoneal removal of retropubic foreignmaterial. It is particularly advantageous when complete sling removal is required and the vaginalapproach is insufficient.