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In the more rare situation where those pelvic areas of the mesh are associated with pain, I favor a laparoscopic approach to the retropubic space to facilitate minimally invasive removal.
5,46,47) Modifications to the TVT have been in response to these complications and clinicians' concern about passing trocars blindly through the retropubic space.
The slings I prefer are placed in a bottom-up fashion, with curved needles passed from a small vaginal incision up through the retropubic space to exit through two suprapubic incisions.
A computed tomography scan showed a 6-cm fluid collection at the mons pubis connected to inflammation within the retropubic space (Fig.
This passage away from the urethra and bladder avoids the retropubic space and therefore reduces the potential for urethral and bladder injury(1) noted with other obturator devices using the 'outside-in' technique.