Misplaced Hysteroscopic Sterilization Micro-Insert in the Peritoneal Cavity: A Corpus Alienum

Abstract

mobilization and reapproximation, followed by placement of a rectus fascia sling. We also describe placement of an alloderm graft to aid in the reapproximation of the rectus fascia. Our patient is 70 year old who presented with large volume urinary leakage along with stress urinary incontinence. On physical exam, no erosion was noted suburethrally, however, the mesh was palpable. She underwent a pelvic ultrasound which revealed two distinct areas of mesh at the midurethra. A pelvic MRI was performed which revealed a bilobed diverticulum. Therefore, she underwent surgical management to remove the midurethral slings, resect the wall of the diverticulum and then repair the urethral defect. We demonstrate mobilization of periurethral flaps and confirmation of urethral repair using the Davis double balloon catheter. Following urethral repair, we perform a Pfannenstiel incision to harvest an 8-10 cm segment of rectus fascia. We used a Varco clamp to facilitate placement and absorbable suture to stabilize the midpoint of the graft at the midurethra. After tensioning the graft, we place alloderm to reapproximate the superior and inferior edges of the rectus fascia. Conclusion: Despite a complicated presentation, we conclude that it is possible and safe to resect two midurethral slings, remove a urethral diverticulum, and treat persistent stress urinary incontinence in a single surgical setting.