Migrated Mesh Plug Masquerading as a Bladder Tumor

Robotic partial cystectomy with excision of mesh after inguinal hernia repair: a case report

BACKGROUND

Mesh erosion into the bladder after hernioplasty is sparsely reported in literature and may be underestimated in clinical practice. We report a case of a patient who was referred to our department due to recurrent urinary tract infections caused by a bladder stone due to mesh migration after inguinal hernia repair 22 years ago.

CASE PRESENTATION

A 67-year-old male patient was referred from the outpatient urologist for transurethral resection of the prostate in September 2021 due to recurrent urinary tract infections caused by benign prostatic enlargement and bladder stone formation. During the operation, parts of the stone were smashed and the prostate was resected. Additionally, a mesh eroding from the bladder roof was detected masqueraded by the stone. A computed tomography scan, which was performed afterwards, revealed a 20 × 25 mm mesh migration into the bladder after inguinal hernia repair on the left with concomitant stone adhesion to the mesh. After revealing patient history, an inguinal hernia repair with mesh implantation was done 22 years ago. A robotic assisted partial cystectomy and mesh excision was performed. The patient recovered well.

CONCLUSION

Mesh erosion into the urinary bladder after hernia repair can occur up to two decades after the primary operation. Although it is rarely reported, it can be a possible cause for recurrent urinary tract infections and therefore a mentionable complication after inguinal hernia operation. Robotic-assisted laparoscopic partial cystectomy with complete excision of the mesh is an option for definitive treatment.

Avoiding migration at open mesh plug inguinal hernioplasty

The open repair of groin hernias is often augmented with prosthetic biomaterials (mesh) as this favours a lower recurrence rate. The use of such prostheses may be associated with various complications including migration the frequency of which is unclear. A 29-year review of this complication after mesh plug hernioplasty is undertaken and technical advice described to avoid this.

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Open Mesh plug inguinal hernia repair needs to be performed methodically.

Urinary bladder fistula following laparoscopic inguinal hernioplasty: a case report

Background

Fistula formation due to mesh erosion into hollow viscera, such as the urinary bladder, is uncommon. To date, there have been no reports of fistula formation into the urinary bladder without evidence of mesh erosion after hernioplasty; herein, we report one such rare case, in which the clinical symptoms improved without any surgical intervention.

Case presentation

A 73-year-old man underwent a trans-abdominal preperitoneal repair for bilateral direct inguinal hernia. One month later, the patient experienced a painful induration in the right inguinal region, and computed tomography revealed fluid collection in this region. A culture of the aspirated fluid yielded no bacteria. Seven months later, he experienced another episode of painful induration in the same region. However, blood examination revealed a normal white blood cell count and C-reactive protein level. Moreover, no organisms were detected by aspirated fluid culture. Although the painful induration subsided after aspiration of the fluid collection, he developed gross hematuria and dysuria a month later. Cystoscopy revealed a fistula in the right wall of the urinary bladder that discharged a purulent fluid. Culture of the fluid revealed no bacteria, and there was no evidence of mesh erosion. Hematuria improved without therapeutic or surgical intervention. The patient’s clinical symptoms improved without mesh removal. Moreover, cystoscopy revealed that the fistula was scarred 12 months after the initial appearance of urinary symptoms. No further complications were observed during a 42-month follow-up period.

Conclusions

We report a rare case of a fistula in the urinary bladder without evidence of mesh erosion after laparoscopic hernioplasty. The patient’s condition improved without mesh removal. Fluid collection due to foreign body reaction to meshes can cause fistula formation in the urinary bladder without direct mesh contact.

Laparoscopic management of mesh migration into urinary bladder following laparoscopic totally extraperitoneal inguinal hernia repair-A case report

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Mesh migration into bladder should be considered a differential in case of patients with recurrent UTI and history of laparoscopic hernioplasty.

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Computed tomography and cystoscopy will aid in the diagnosis of such cases and removal by TAPP approach is better than other approaches.

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This case report will help the readers to get a knowledge on such an approach as it is easily reproducible.

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Care should be taken to remove all the mesh as remnant mesh particles may act as a nidus for infection.

Introduction and importance

Mesh migration into urinary bladder is one of the rare complications following inguinal hernia repair (Laparoscopic/Open). On reviewing the literature, erosion of mesh following inguinal hernia repair has been into the urinary bladder in most of the cases, and the erosion may occur as early or late complication. It may occur as a result of improper suturing, inadequate fixation or foreign body reaction. The most common presentation is recurrent urinary tract infection and haematuria and may mimic bladder malignancy.

Case presentation

A 38-year male presented with recurrent UTI and mimicked to have bladder malignancy on CT scan. On Cystoscopy, mesh along with tackers is visualized within the bladder lumen. A diagnosis of Mesh migration into bladder following laparoscopic inguinal hernia repair was made. The Patient underwent Complete laparoscopic removal of mesh with partial cystectomy, per urethral and suprapubic catheter were placed. The patient made a good recovery without any post-operative complications. On follow-up, Patient underwent Fluoroscopy to look for urinary leakage, and suprapubic catheter removal was done. Patient is asymptomatic on follow-up.

Clinical discussion

Mesh migration into bladder is one the rare complications following laparoscopic hernia repair. Proper preoperative evaluation is necessary to determine whether mesh is free floating in the bladder lumen or adherent to bladder wall. This will help in deciding the surgical technique for route of extraction.

Conclusion

A case of mesh migration into the bladder can be easily managed by laparoscopic TAPP approach and it is better approach compared to other techniques.

Mesh erosion into urinary bladder, rare condition but important to know

BACKGROUND

Although rare, mesh migration or erosion into viscera has been reported as case report, and most of the cases involved with the urinary bladder. With the increasing use of prosthetic mesh in hernia repair, this severe complication would increase in the future; thus, we feel that it is necessary to analyze the clinical patterns of mesh erosion into the urinary bladder, and to discuss the prevention and treatment of this severe complication.

METHOD

In the present study, we made a thorough identification of all published reports on mesh migration or erosion into the urinary bladder, and the data were summarized, analysed, and discussed.

RESULTS

A total of 23 cases of mesh erosion into urinary bladder were reported since 1994. Among them, two cases were from incisional hernia repairs, and 21 cases were following inguinal hernia repairs. The most frequently reported procedures were TAPP, followed by TEP. The duration from initial hernia repair to the onset of mesh erosion into bladder varied greatly (3 months-20 years), and most of cases occurred in 1-5 years after the initial hernia repair (10/23, 43.5%), while a certain number of cases occurred 10 years after hernia repair (6/23, 26.1%). Most of these cases were treated with mesh removal via a open procedure (12/22, 54.5%), and in 7 cases (7/22, 31.8%), the partial cystectomy was performed as well as mesh removal. Laparoscopic or robotic treatment procedures were performed in three cases.

CONCLUSION

Mesh erosion into the urinary bladder can occur after both open and laparoscopic inguinal hernia repairs in a wide range of duration. This complication most frequently happened following laparoscopic inguinal hernia repair. It was usually treated with partial or complete mesh removal, with or without partial cystectomy. A registry system is necessary for monitoring this complication.