Laser excision of urethral mesh erosion: a 10-year experience.

PURPOSE: To review our 10-year experience with laser excision for urethral mesh erosion (UME) of mid-urethral slings (MUS). METHODS: Following Institutional Review Board approval, the charts of female patients with endoscopic laser excision of UME were retrospectively reviewed. Demographics, clinical presentation, surgical history, pre- and post-operative Urinary Distress Inventory-6 scores and quality of life ratings, operative reports, and outcomes were obtained from electronic medical records. UME cure was defined as no residual mesh on office cystourethroscopy 5-6 months after the final laser excision procedure. RESULTS: From 2011 to 2021, 23 patients met study criteria; median age was 56 (range 44-79) years. Twenty (87%) had multiple prior urogynecologic procedures. Median time from MUS placement to presentation with UME-related complaints was 5.3 [interquartile range (IQR) 2.3-7.6] years. The most common presenting symptom was recurrent urinary tract infection (rUTI) (n = 10). Median operating time was 49 (IQR 37-80) minutes. Median duration of follow-up was 24 (IQR 12-84) months. Fourteen (61%) required more than 1 laser excision procedure for UME. Although 5 were asymptomatic (22%), new (n = 5) or persistent (n = 8) urinary incontinence was the most common symptom on follow-up (57%). CONCLUSION: UME presenting symptoms are highly variable, necessitating a high index of suspicion in patients with a history of MUS, especially in the case of rUTI. Endoscopic laser excision is a minimally invasive, brief, safe, outpatient procedure with a high UME cure rate.

Vaginoscopy With Laser Treatment of Symptomatic Upper Vaginal Mesh Exposure After Prior Mesh Sacrocolpopexy.

OBJECTIVE: To describe the technique of vaginoscopy with Holmium:YAG and Thulium laser treatment of upper vaginal mesh exposure after mesh sacrocolpopexy (MSC) as well as evaluate treatment efficacy. METHODS: Following IRB approval, a chart review of all patients who underwent laser treatment of upper vaginal mesh exposure during vaginoscopy at a single institution between 2013 and 2022 was performed. Demographic information, previous mesh placement history, presenting symptoms, physical examination and vaginoscopy findings, imaging, laser type and settings, operating time, complications, and follow-up including examination and office vaginoscopy findings were extracted from electronic medical records. RESULTS: Five patients and 6 surgical encounters were identified. All patients had a history of MSC and symptomatic mesh exposure at the vaginal apex, which was tented up and difficult to access by traditional transvaginal mesh excision. Five patients underwent vaginal mesh treatment with laser with no further vaginal mesh exposure on follow-up exam or vaginoscopy. One patient was found to have a small recurrence at 4 months and underwent a second treatment with negative findings on vaginoscopy 7.9 months post-operatively. There were no complications. CONCLUSION: Vaginoscopy using a rigid cystoscope and laser treatment of upper vaginal mesh exposure using a Holmium:YAG or Thulium laser is a safe and quick method which led to definitive symptom resolution.

Objective Assessments of Peyronie's Disease.

INTRODUCTION: Penile deformity is the most obvious manifestation of Peyronie's disease (PD) and key to determining the optimal method of treatment. Other aspects of PD to consider include plaque size, location, and density; amount of calcification; erection quality; disease progression; and penile anatomy. Few standards exist for the objective assessment of these parameters. AIM: To describe current options and new trends in the objective evaluation of PD with a focus on penile curvature and imaging modalities. METHODS: A literature review was performed through PubMed from 1990 to 2017 regarding objective parameters in PD, including imaging modalities, measurements of deformity, and serum markers. Non-English-language articles were excluded. MAIN OUTCOME MEASURES: We sought to assess various objective measurements obtained in patients with PD and to evaluate their usefulness in the evaluation, treatment, and counseling of patients with PD. RESULTS: Measurement of penile curvature is most accurately performed with in-office goniometric angle measurement of a pharmacologically induced erection. However, new methods of assessing penile curvature using 3-dimensional photography and smartphone and tablet applications can aid clinicians in describing and treating PD. Ultrasound and ultrasound adjuncts provide excellent plaque characterization and assessment of penile vasculature, which can be useful for treatment planning and research. Presence of inflammation can be evaluated using magnetic resonance imaging or nuclear scintigraphy. CONCLUSION: Current guidelines only recommend obtaining measurements of penile length and penile curvature in the erect state. However, many other options exist for the objective evaluation of PD. These options can have a role in treatment decision making and help standardize results in PD research. Chen JY, Hockenberry MS, Lipshultz LI. Objective Assessments of Peyronie's Disease. Sex Med Rev 2018;6:438-445.