The objective of this study is to determine the outcomes associated with the endoscopic removal of foreign bodies (such as mesh or permanent suture) in the lower urinary tract after female stress incontinence surgery with the Holmium:YAG (Ho:YAG) laser, and systematically review the literature on this topic.
A retrospective chart review of 18 consecutive women found to have mesh or suture exposure was performed. All patients underwent Ho:YAG laser ablation. A systematic review was performed to identify literature addressing the endoscopic management of mesh/suture exposure after stress incontinence surgery.
Between November 2011 and February 2016, 18 women underwent Ho:YAG laser ablation of exposed mesh or suture. Presenting symptoms included lower urinary tract symptoms, pelvic pain, incontinence or recurrent urinary tract infections. Thirteen women had a previous synthetic midurethral sling (MUS) and five had a prior retropubic suspension. The median age was 58 years, (IQR 50-60) and median follow up was 2 years (IQR 1-2). Four patients (22%) had residual mesh after the first procedure, requiring a repeat endoscopic procedure. Only 1 patient had a small amount of asymptomatic residual mesh on cystoscopy after the final procedure. Only minor postoperative complications were observed. Eight patients had stress incontinence, and 4 (22%) underwent operative treatment for this. In our systematic review, we identified 16 case series, which described a total of 158 patients. Women most commonly presented with voiding symptoms or incontinence. Based on the synthesis of this data, repeat procedures were necessary in 16%, and vesicovaginal fistula occurred in 2%. Recurrent/persistent stress incontinence was present in 20%, and of these patients, ¾ underwent a new stress incontinence procedure.
Both our case series, and the systematic review of the literature, demonstrated that endoscopic treatment of lower urinary tract foreign bodies after stress incontinence surgery has good success rates and minimal morbidity.
Journal of endourology / Endourological Society. 2016 Sep 07 [Epub ahead of print]
Garson Chan, Adiel Mamut, Paul Martin, Blayne Welk
Western University, Surgery, London, Ontario, Canada ; ., Western University, Surgery, London, Ontario, Canada ; ., Western University, Surgery, London, Ontario, Canada ; ., Western University, Surgery (Urology) , 268 Grovsenor St , London, Ontario, Canada , N6C 2N9 ; .