Late complications of suburethral slings include chronic pelvic pain and recurrent urinary tract infections (UTIs). Pudendal nerve involvement is an underrecognized cause, particularly in patients with prior complex pelvic surgery.

A 47-year-old woman with a history of hypothyroidism, hysterectomy, and prior colposacropexy (Upsylon) with transobturator tape (TOT) placement complicated by right ureteral injury (2019), requiring ureteral reimplantation (2020), was referred for a second opinion due to recurrent UTIs.
She presented with suprapubic pain radiating to the lower limbs and eight UTIs in the previous year. Physical examination revealed right paraurethral tenderness without mesh extrusion. Cystoscopy and urodynamic evaluation were normal. Voiding cystourethrogram showed minimal right-sided vesicoureteral reflux. CT scan confirmed right ureteral reimplantation and a left ureterocele. Neurophysiological findings were consistent with bilateral pudendal nerve entrapment, predominantly on the right side.

Fixation of the sigmoid colon to the abdominal wall. Anterior peritoneal incision. Right paraurethral dissection with identification of the prior mesh. The right pudendal nerve was identified under intraoperative neuromonitoring and the right mesh arm was transected. Identification of the left mesh arm and ipsilateral pudendal nerve, followed by dissection and transection. Complete mesh removal was achieved. Hemostasis and peritoneal closure were performed.

Postoperative course was uneventful. Catheter was removed on postoperative day 7. The patient reported significant improvement in pain. Uroflowmetry showed Qmax 30 mL/s, voided volume 613 mL, and postvoid residual 13 mL. No UTIs have occurred since surgery. Ongoing follow-up with Gynecology.

Robotic sling removal combined with pudendal nerve release is an effective option in selected patients with chronic pelvic pain and recurrent UTIs following mesh surgery. Identification of the neuropathic component is essential for optimal outcomes.