Sacrocolpopexy (SCP) is a well-established and durable surgical treatment for apical pelvic organ prolapse. While mesh-related complications such as erosion and infection are recognized, delayed mesh infection leading to vesicovaginal fistula (VVF) is rare and challenging to manage. We aim to describe the clinical course and surgical management of a complex VVF associated with late SCP mesh infection, highlighting key principles for successful robotic repair.

This original report describes the case of a 39-year-old woman with a history of laparoscopic supracervical hysterectomy, bilateral salpingectomy, and SCP. Within one year postoperatively, she developed chronic pelvic pain and malodorous vaginal discharge. Imaging demonstrated a pelvic abscess tracking along the mesh. She underwent robotic trachelectomy with partial mesh excision and uterosacral ligament suspension.
Subsequently, the patient developed continuous urinary leakage. Cystoscopic evaluation confirmed a vesicovaginal fistula located at the posterior bladder wall. An initial attempt at repair at an outside institution was unsuccessful in the setting of severe pelvic inflammation.
Definitive repair was deferred for 4–6 months to allow resolution of inflammation. Preoperative magnetic resonance imaging confirmed absence of active infection or abscess. The patient then underwent robotic-assisted laparoscopic fistula repair and complete mesh excision.
Intraoperatively, cystoscopy with bilateral ureteric catheter placement was performed. Dense adhesions and residual mesh were identified and carefully dissected. The fistula tract between the posterior bladder wall and vaginal cuff was isolated. The bladder defect was closed in two watertight layers, followed by separate closure of the vaginal cuff. A peritoneal flap was interposed between the two suture lines to reinforce the repair. A Foley catheter was maintained postoperatively for three weeks.

Postoperative cystography at three weeks demonstrated no contrast extravasation, confirming successful fistula closure. The Foley catheter was removed without complications. The patient experienced complete resolution of urinary leakage and pelvic symptoms. At follow-up, there was no evidence of recurrent fistula or infection.

Although rare, late SCP mesh infection and fistula formation may occur. Persistent pelvic pain after SCP should prompt evaluation for occult infection. Complete mesh excision, watertight closure, and tissue interposition are critical for successful robotic VVF repair and recurrence prevention.