Robotic midurethral sling removal: surgical technique and outcomes of a single center series.

OBJECTIVE

To describe the spectrum of robotic surgical techniques used for removal of synthetic midurethral slings (MUS) in different mesh-related complications and to report perioperative and functional outcomes in a tertiary referral setting. Robotic MUS removal has recently emerged as an alternative approach; however, data regarding its indications, technical aspects and outcomes remain limited.

MATERIALS AND

METHODS

We analyzed a prospectively maintained database of all female patients who underwent robotic MUS removal at a single tertiary referral center between August 2022 and July 2025. Indications for surgery included pain, mesh exposure, or patient request for complete removal. Depending on the indication and shared decision-making process, either complete removal of all remaining mesh components or partial removal of the extruded segment was planned. Patients with preoperative stress urinary incontinence (SUI) were offered concomitant robotic autologous fascial sling placement, whereas those without preoperative SUI underwent pubourethral ligament plication. Outcomes assessed included postoperative complications (Clavien-Dindo classification), pain evaluated using a visual analog scale (VAS), continence outcomes, Patient Global Impression of Improvement (PGI-I), and need for reintervention.

RESULTS

Seventy patients were included. The planned extent of mesh excision was achieved in all patients; complete removal of all remaining mesh components was performed in 74 cases and partial removal in 6 cases. Median operative time was 160 min, and median length of hospital stay was 3 days (range 0-21). Major complications (Clavien-Dindo ≥ III) occurred in 6 patients (8.6%). At last follow-up, 62 patients (88.6%) reported symptom improvement, including 49 (70%) with PGI-I scores of 1-2. Stress urinary incontinence remained a relevant postoperative concern, and 11 patients (15.7%) ultimately required additional continence treatment.

CONCLUSIONS

Robotic MUS removal is a feasible approach associated with high rates of patient-reported symptom improvement. However, continence outcomes should be interpreted cautiously given the heterogeneity of the population and the frequent use of concomitant anti-incontinence procedures.