Mesh erosions following previous synthetic sling/mesh surgery for stress urinary incontinence (SUI) have become increasingly common. This systematic review provides evidence for the role of laser excision as a first-line management in patients with eroded mesh.
Fourteen articles (173 patients) were included for the final review. Among these, 138 patients (79.8%) were submitted to trans-urethral laser excision of eroded urethral/bladder mesh over a median time to presentation of 36.6 months. Over a median follow-up of 23.6 months, 88 (63.7%) reported a complete resolution, 32 (23.2%) reported persistence or recurrence of SUI and 17 (12.3%) presented with recurrent mesh erosion. The success rate after a single endoscopic procedure was 66.5, vs. 93.5% after additional endoscopic procedures, with only 9 (6.6%) requiring open surgical excision. Overall, there were seven (5.1%) postoperative complications including two urethrovaginal fistulas, two UTIs and haematuria each, and one case of urethral diverticulum.
Laser excision of eroded mid-urethral slings into either the bladder or urethra is a challenging complication of minimally invasive incontinence surgery. Laser excision was able to achieve a good success rate with single or staged endoscopic procedure with a low risk of complication. It represents a valid first treatment option, although patients should be managed in mesh referral centres in collaboration with uro-gynaecology teams.
Current opinion in urology. 2023 Nov 07 [Epub ahead of print]
Francesco Ripa, Dmitry Enikeev, Ali Talyshinskii, Patrick Juliebø-Jones, Lazaros Tzelves, Panagiotis Kallidonis, Bhaskar Somani
Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK., Department of Urology, Medical University of Vienna, Vienna, Austria., Department of Urology, Astana Medical University, Astana, Kazakhstan., Department of Urology Haukeland and Department of Clinical Medicine, University Hospital, Bergen, Norway., Department of Urology, University College of London Hospital, London, UK., Department of Urology, University of Patras, Patras, Greece.