Should endoscopic laser excision be offered as the first-line management for patients with eroded mesh? Outcomes of a systematic review of literature

Ripa F. Enikeev D. Talyshinskii A. Juliebø-Jones P. Tzelves L. Kallidonis P. Somani B.
1 March 2024 Lippincott Williams and Wilkins

Current Opinion in Urology
2024 #34 Issue 2 135 - 144 pp.

Purpose of reviewMesh 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.Recent findingsFourteen 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.SummaryLaser 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.

erosion , excision , laser , mesh , tape , tension-free vaginal tape

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Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, United Kingdom
Department of Urology, Medical University of Vienna, Vienna, Austria
Urology Department, Rabin Medical Center, Petah Tikva, Israel
Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russian Federation
Department of Urology, Astana Medical University, Astana, Kazakhstan
Department of Urology Haukeland, Department of Clinical Medicine, University Hospital, Bergen, Norway
Department of Urology, University College of London Hospital, London, United Kingdom
Department of Urology, University of Patras, Patras, Greece

Department of Urology
Department of Urology
Urology Department
Institute for Urology and Reproductive Health
Department of Urology
Department of Urology Haukeland
Department of Urology
Department of Urology

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