Endoscopic management of intraurethral mesh extrusion with the holmium:YAG laser is an acceptable treatment option in selected patients.

ABSTRACT

INTRODUCTION: Extrusion of transvaginal mesh into the urethra is a rare but potentially serious complication. Our objective is to evaluate the efficacy and long-term outcomes of women who underwent an endoscopic laser procedure to treat intraurethral mesh. MATERIALS AND METHODS: A retrospective chart review identified women who underwent an endoscopic HolmiumYAG laser procedure to treat intraurethral mesh between September 2011-October 2021. Information about the procedure, symptoms, and level of incontinence was gathered from the medical records. Primary outcomes were the need for further procedures, and the Urinary Distress Index-6 score at last follow-up. RESULTS: We identified a total of 29 women; mesh sling procedure included tension-free vaginal sling (19), transobturator sling (6), or other transvaginal mesh sling (4). Presentation of intraurethral mesh was a median of 6 (interquartile range [IQR] 1-7) years after placement. After the endoscopic procedure, 18/29 (62%) women had no visible urinary mesh and complete resolution of their presenting symptoms. Retreatment was necessary in 3/29 women, and 6/29 (21%) reported new or worsening stress incontinence. The UDI-6 was completed by all patients at a median of 3.7 (IQR 2.0-5.8) years after their endoscopic procedure. The median score was 22 (IQR 11-44), and 18/29 (62%) women had scores in the asymptomatic range. UDI-6 scores were similar for the six women who had further mesh procedures and the ones who did not. CONCLUSIONS: Endoscopic laser treatment of an eroded transvaginal mesh sling is an acceptable treatment with minimal morbidity and satisfactory UDI-6 scores after a median follow-up of 3.7 years.