Pubo Suburethral Suture Placement for Treatment of Stress Urinary Incontinence in a Woman with Mesh Exposure and Recurrent Incontinence

Objective: To present and assess the pubo suburethral suture placement (PSUSP) technique as a surgical treatment option for stress urinary incontinence (SUI) in patients with previous mesh exposure and recurrent incontinence. This technique aims to offer an alternative approach for patients where conventional methods may be contraindicated or have previously failed. The PSUSP procedure involves strategic suture placement to reinforce the pubovaginalis fascia, potentially enhancing structural support and functional outcomes. Case: A 56-year-old woman who had undergone transobturator tape (TOT) surgery 3 years prior presented with SUI. Clinical examination revealed persistent SUI and suburethral mesh exposure. Under spinal anesthesia, partial dissection and removal of the exposed mesh were performed. The vaginal mucosa was dissected from the pubocervical fascia to the pubic bone bilaterally. A zero polyester suture was passed through the retropubic fibrous tissue and the pubovaginalis fascia parallel to the urethra on the left side, and the procedure was mirrored on the right side. Twenty days postoperatively, the patient reported mixed urinary incontinence, and examination revealed local incisional dehiscence, suture detachment, and persistent SUI. A reoperation was conducted using a vertical incision. The vaginal mucosa was re-dissected from the pubocervical fascia, and PSUSP was re-implemented as previously described. The pubovaginalis fascia was repaired before the PSUSP sutures were secured. Postoperative evaluation indicated the resolution of mixed incontinence, with no further complications reported. Conclusion: This case illustrates that PSUSP can be a viable surgical technique for treating SUI in patients with a history of mesh exposure and recurrent incontinence. The reoperation success suggests that PSUSP may provide enhanced support to the pubovaginalis fascia, but further clinical studies are necessary to evaluate its long-term efficacy and safety profile.