A surprise in the bladder: The case of the misplaced gortex

A fifty-three year old vaginally primipara was evaluated for urinary mixed incontinence symptoms and POP-Q stage II pelvic organ prolapse. Her past medical history was significant for Burch colposuspension conducted six years prior to her referral. Review of the operative report indicated prior use of six peri-urethral gortex sutures attached to Cooper's ligament. There was no documentation of cystoscopy at the end of the procedure. Following the surgery, the patient had persistent stress urinary incontinence symptoms and multiple episodes of poorly documented urinary tract infections. After evaluation for worsening symptoms of mixed urinary incontinence and symptomatic prolapse, the patient underwent a suburethral rectus fascial sling and sacrocolpopexy for her pelvic organ prolapse. Following an uneventful procedure, cystoscopy to document lower urinary tract safety revealed a urothelial-covered gortex suture and tissue bridge in the bladder. The gortex suture was found to be attached to Cooper's ligament, consistent with patient's prior history of Burch colposuspension. Via the open abdominal incision, the intravesical suture was cut at its connection to Cooper's ligament. Through a transvesical approach, the intravesical suture and tissue bridge were incised and removed. The postoperative course was uneventful. This case report emphasizes the importance of intraoperative cystoscopy following an incontinence procedure. This abnormal appearance of the bladder lining is consistent with intravesical surgical materials complications. Intravesical surgical materials may contribute to persistent urinary symptoms or recurrent urinary tract infections (UTIs) in selected women. Detection and removal of these materials is recommended.