A 29-year-old female patient presented initially with symptoms of stress urinary incontinence occurring several times every day, for 4 years. She also reported symptoms of urgency and urge urinary incontinence and pelvic dragging. In the past she had 2 uncomplicated spontaneous vaginal deliveries and she suffered from asthma that was well controlled by medical treatment (bronchodilators by inhalation).

Physical examination revealed a moderate cystocele with paravaginal defects, a small rectocele, and a first-degree uterine prolapse. Urodynamic investigation showed urodynamic stress incontinence. As previous conservative treatment with pelvic floor exercises and physiotherapy had failed, she underwent a Burch colposuspension. The procedure and the recovery were uneventful and the stress urinary incontinence was cured.

Ten months after surgery the patient reported increasing pelvic dragging sensation. Clinical examination revealed a moderate rectoenterocele and 1st-2nd degree of uterine prolapse with an elongated cervix and a small high cystocele. The patient underwent a Manchester procedure with repair of cystocele using a polypropylene mesh (Prolene). The uterus was also suspended by the posterior IVS (intravaginal slingplasty) technique. Pelvic organ prolapse symptoms were subsided.

However, the patient noted an offensive vaginal discharge 3 months after the second operation and she reported an episode of light vaginal bleeding. Examination revealed a large mesh erosion of the anterior vaginal wall (2x3cm) (Figure 1) and 2 small erosions of the IVS tape on the posterior vaginal wall. The uterus and the vaginal walls were well supported.