Laser Excision of Urethral Mesh Erosion: A 10-Year Experience

Urethral mesh sling erosions are challenging to manage and are usually dealt with by a transvaginal procedure during which a large urethrotomy has to be repaired once the eroded mesh has been removed. This procedure can be complicated by secondary incontinence from intrinsic sphincteric damage, urethrovaginal fistula, and/or urethral stricture.

For the past 10 years, we have approached this mid-urethral sling complication by laser endoscopy. This brief and outpatient technology allows a precise excision of the mesh segment eroded in the urethral lumen without damage to the surrounding urethral wall structures. We have used the YAG laser for many years, and more recently the Thulium laser with excellent results.

Some patients will require a few procedures to completely eliminate all exposed mesh fibers, especially clear ones which might be difficult to visualize when they are laterally retracted. We have had a few tiny urethrovaginal fistulae with residual mesh material on the floor of the mid-urethra, requiring a secondary limited vaginal procedure to remove these residual small mesh fragments, close the small fistula, and interpose an autologous fascial sling to prevent fistula recurrence and to aid with continence restoration. Admittedly, these complications are rare and should be dealt with in specialized tertiary care centers.

Written by: Philippe E. Zimmern, Professor of Urology, Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX

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