MAUDE Adverse Event Report: COLOPLAST A/S RESTORELLE POLYPROPYLENE MESH FOR SACROCOLPOPEXY, SACROCERVICOPEXY, AND SACROHYS; PELVIC ORGAN PROLAPSE SURGICAL MESH, SYNTHETIC POLYMER

Catalog Number	501420
Medical Device Problem Code	Malposition of Device (2616)
Health Effect - Clinical Codes	Erosion (1750); Micturition Urgency (1871); Pain (1994); Urinary Retention (2119); Urinary Tract Infection (2120); Urinary Frequency / Polyuria (2275); Hematuria (2558); Intermenstrual Bleeding (2665); Dysuria (2684); Dyspareunia (4505); Cramp(s) /Muscle Spasm(s) (4521); Urinary Incontinence (4572); Pelvic Pain (4865)
Date of Event	10/28/2024
Type of Reportable Event	Serious Injury
Event or Problem Description
As reported to coloplast, though not verified: the patient reportedly had a supris and restorelle y implanted in (b)(6) 2019.Subsequently, the patient experienced hematuria, mesh erosion at right lateral wall/bladder neck encrusted with stone, pelvic pain, right hip pain and recurrent urinary tract infections.The patient underwent examination under anesthesia, partial controlled cystectomy and cystoscopy.Robotic assisted removal of right arm of mesh was performed (complex/tedious) and cystotomy repair with 2 layer closure was performed.Intraoperative findings included right sling arm malpositioned lying along right anterior bladder wall and aimed high up in abdominal wall with no exit point (~8 cm above normal suprapubic exit point), mesh attached to bladder on right side with associated calcifications into bladder wall posterior and lateral to right ureteral orifice.
Additional Manufacturer Narrative
The lot number was reviewed for complaint trend, nonconforming report and capa.Devices met specification prior to release.No trends were noted for complaints and there were no nonconforming reports or capas that were confirmed in veeva to be associated.The device was not returned for evaluation.Without the benefit of analyzing the device, coloplast cannot comment on the condition of the device.Should additional information prompt us to alter or supplement any information or conclusions contained in this report, a follow-up report will be submitted.
Event or Problem Description
As additionally reported to coloplast, though not verified, the patient also experienced urinary urgency/frequency, nocturia, feeling of incomplete bladder emptying, random blood in toilet after sex, dysuria after sex, urinary tract infections resistant to antibiotics, dyspareunia, persistent urethral burning (worse in am then improves), recurrent stress urinary incontinence with full bladder, left hip pain and muscle spasm/ high-tone pelvic floor dysfunction.
Additional Manufacturer Narrative
This complaint was investigated to the extent information was provided to coloplast.Due to the legal nature of this complaint and the device not being returned for evaluation a thorough investigation could not be executed.Should additional information become available, this file will be re-evaluated and updated according to current procedures.Complaints of this nature are monitored and captured within the product risk documentation.No further action or corrective action is required at this time.D10: 51956 supris retropubic kit.Therapy date (b)(6)2019.

• Brand Name: RESTORELLE POLYPROPYLENE MESH FOR SACROCOLPOPEXY, SACROCERVICOPEXY, AND SACROHYS
• Common Device Name: PELVIC ORGAN PROLAPSE SURGICAL MESH, SYNTHETIC POLYMER
• Manufacturer (Section D): COLOPLAST A/S; 1 holtedam humlebaek, dk 3050; humlebaek 3050 ; DA 3050
• Manufacturer (Section G): MINNEAPOLIS
• Manufacturer Contact: usbes brian schmidt ; 1601 west river road n; minneapolis, MN 55411
• MDR Report Key: 23960021
• Report Number: 2125050-2026-00012
• Device Sequence Number: 21235206
• Product Code: OTO
• Combination Product (Y/N): N
• Initial Reporter Country: US
• PMA/510(K) Number: K132061
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2019
• Device Explanted Year: 2025
• Serviced by Third Party (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Consumer
• Initial Reporter Occupation: Non-Healthcare Professional
• Type of Report: Initial,Followup
• Report Date (Section B): 05/21/2026

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: Yes
• Operator of Device: Health Professional
• Device Expiration Date: 10/24/2021
• Device Catalogue Number: 501420
• Device Lot Number: 6427315_5014202400
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: No
• Was the Report Sent to FDA?: No
• Type of Report(Section G): Initial
• Initial Date Received by Manufacturer: Not provided
• Supplement Date Received by Manufacturer: Not provided
• Initial Report FDA Received Date: 01/05/2026
• Supplement Report FDA Received Date: 05/21/2026
• Was Device Evaluated by Manufacturer? (Y/N): No
• Date Device Manufactured: 11/14/2018
• Is the Device Labeled for Single Use? (Y/N): Yes
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Usage of Device: Initial
• Patient Sequence Number: 1
• Outcome Attributed to Adverse Event: Required Intervention
• Patient Age: 41 YR
• Patient Sex: Unknown