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. 2025 Apr 24;14(3):259-263.
doi: 10.4103/gmit.gmit_86_24. eCollection 2025 Jul-Sep.

How to Deal with Bladder Stones Associated with Exposed Intravesical Mesh

Purim Ruanphoo  1 , Jimmy Nomura  1 , Tokumasa Hayashi  1 , Shino Tokiwa  1 , Mika Nagae  1 , Divina Soliza  1 , Antonette Pesebre  1 , Albert Ayumba  1 , Hisao Kaneko  1
Affiliations

How to Deal with Bladder Stones Associated with Exposed Intravesical Mesh

Purim Ruanphoo et al. Gynecol Minim Invasive Ther. .

Abstract

We present the management of seven patients who were diagnosed with bladder stone associated with exposed intravesical mesh after transvaginal mesh (TVM) surgery for pelvic organ prolapse. The TVM may be exposed inside the bladder which can result in urinary stone formation. Several treatment modalities have been proposed such as laser lithotripsy, transurethral resection, and open or laparoscopic resection of exposed mesh. However, the optimal route of treatment remains inconclusive. In our series, two cases were managed by transurethral resection and one of them had recurrence. Five cases were managed by laparoscopic resection and one of them had recurrence. Two recurrent cases underwent laparoscopic resection and then no recurrence occurred. No intraoperative or postoperative complications occurred. Although there is limited evidence, we recommend laparoscopic resection for the treatment of intravesical mesh exposure. Offering transurethral resection as an initial management of intravesical mesh exposure is possible with careful discussion about the recurrence rate.

Keywords: Bladder stone; intravesical mesh exposure; management; transvaginal mesh; treatment.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Technique for transurethral resection of the exposed intravesical mesh; (a) Identification of bladder stone by urethrocystoscopy; (b) Transurethral lithotripsy was performed by Holmium laser; (c) Identification of the exposed intravesical mesh (white arrow); (d) Excision of the exposed mesh by bipolar wire-loop resectoscope
Figure 2
Figure 2
Technique for laparoscopic resection of the exposed intravesical mesh; (a) A vertical cystotomy incision was created using monopolar scissors; (b) Bladder wall was temporarily suspended to the abdominal wall for optimal exposure; (c) The area of exposed intravesical mesh was then identified, and dissection commenced with monopolar scissors to incise the bladder mucosa; (d) The exposed mesh was grasped with forceps, and circumferential dissection continued along a plane close to the mesh, using blunt and sharp dissection to separate the mesh from surrounding tissues; (e) The bladder wall was sutured in layers to cover the exposed area (vaginal muscular layer and bladder layer); (f) Cystotomy incision was closed in 2 layers and leak test was performed
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