V2-05: HOLMIUM LASER EXCISON OF GENITOURINARY MESH EROSION
Mesh exposure into the genitourinary (GU) tract following surgery for stress urinary incontinence (SUI) is a rare but potentially serious complication. Transurethral endoscopic management of GU mesh exposure has been utilized as a minimally invasive approach with reported success in small series. We evaluated our patient outcomes following transurethral endoscopic excision using the holmium laser (TEEH) for foreign material after anti-incontinence surgery and previously presented our data. Here we also present the technique.
Between May of 2011 and July of 2013, 10 patients underwent TEEH at our institution. Of these, nine had a prior urethral sling placed and one had suture erosion following a Marshall-Marchetti-Krantz procedure. All patients underwent TEEH with the 550-micron laser fiber and Holmium laser settings of 1.5-2 Joules and 20-30 Hertz. Video was taken of a number of the procedures, and two are presented here, a bladder erosion and a urethral erosion. Outcomes assessed included resolution of symptoms, successful treatment of exposed mesh as seen on repeat cystoscopy, and recurrence of stress urinary incontinence following treatment with TEEH. Patient follow-up was obtained through office examination, cystoscopy and/or through written or telephone correspondence.
Patients with mesh erosion most commonly presented with irritative voiding symptoms, 50%. The location of erosion was the urethra in 4 patients and the bladder in 5 patients. The procedure was outpatient in all cases, and the median operative time was 27 minutes (IQR 20;44). A catheter was left in place for a median of 3 days postoperatively (IQR 0;7). No patients experienced Clavien Grade III-V complications. Median symptom follow-up was 27 months (IQR 16;37) with 8/10 (80%) patients reporting symptomatic improvement. Eight patients underwent follow-up cystoscopy at a median of 8 months with 5/8 (63%) negative for recurrence. Notably, three patients experienced recurrent SUI following TEEH, with one patient undergoing repeat anti-incontinence surgery.
TEEH is a viable, minimally invasive option for management of GU mesh erosion, with excellent overall symptomatic success and relatively low retreatment rate. Notably, there is a risk for recurrent SUI following laser mesh excision.