Synthetic mesh mid urethral slings (MUS) are considered the current gold standard treatment for stress urinary incontinence (SUI). Since it was first described by Ulmsted et al. in 1996 (1), the retropubic tension free vaginal tape (TVT) has been extensively researched, with numerous high-quality trials demonstrating a good safety profile with high long-term efficacy (2). Nevertheless, recent high profile lawsuits and subsequent media attention surrounding vaginal mesh products for treatment of prolapse has placed pressure to ban all mesh products including the MUS. The RANZCOG position statement currently supports the use of MUS, but highlights the need to obtain appropriate surgical training and demonstrate knowledge of operative complications (3).
This video demonstrates the case of a 55 year old female who presented as a tertiary referral for severe SUI and prolapse 1 year following a failed anterior, posterior and vaginal vault repair. Examination revealed a stage 3 cystocele, a stage 2 rectocele and a stage 2 vault prolapse. Urodynamics confirmed the presence of marked SUI with intrinsic sphincter deficiency. A laparoscopic sacrocolpopexy was performed in conjunction with a TVT under direct laparoscopic vision. This unique perspective allows the path of the trocar to be visualised as it passes through the space of Retzius, providing an improved understanding of anatomical relations and potential complications that may be encountered.