Holmium laser excision for urinary mesh erosion: a minimally invasive treatment with favorable long-term results.

introduction and hypothesisMesh erosion into the urinary tract following surgery for stress urinary incontinence is a potentially serious complication. Traditional open resection is complicated and potentially morbid. Therefore, we sought to evaluate the long-term patient outcomes following transurethral endoscopic excision using the holmium laser (TEEH).

methodsA retrospective series of ten patients who had undergone TEEH at our institution between May 2011 and July 2014 were identified. Nine had a prior urethral sling placed, and one had suture erosion following a Marshall-Marchetti-Krantz procedure. Outcomes assessed included resolution of symptoms, successful treatment of exposed mesh on repeat cystoscopy, and recurrence of stress urinary incontinence. Patients were followed up through office examination, cystoscopy and/or through written or telephone correspondence.

resultsThe median age of the patients at the time of surgery was 58 years (IQR 54 - 66 years). The median time from anti-incontinence surgery to onset of symptoms was 12 months (IQR 1 - 72 months). Patients with mesh erosion most commonly presented with irritative voiding symptoms (60%). The median follow-up was 27 months (IQR 14 - 32 months) with 80% of patients reporting symptomatic improvement. Eight patients underwent follow-up cystoscopy with anatomic success (resolution of erosion on cystoscopy) after one procedure in five patients (63%). The anatomic success rate was higher for bladder erosions than for urethral erosions (80% vs. 33%). Notably, three patients experienced recurrent stress urinary incontinence following TEEH, with one patient undergoing repeat anti-incontinence surgery.

conclusionsTEEH is a viable, minimally invasive option for management of urinary mesh erosions. Notably, there is a risk of recurrent stress urinary incontinence following laser mesh excision.