title: Endoscopic holmium laser management of tension-free vaginal tape eroded into the bladder.
abstract: BACKGROUND
  Tension-free vaginal tape (TVT) procedure is not free from intra- and postoperative complications. Diagnosis of mesh erosion is often underestimated by clinicians due to its unspecific symptoms. Urinary symptoms not responding to medical therapy should be investigated by cystoscopy to exclude mesh erosion. We report our experience with holmium laser for the endoscopic management of mesh erosion in three patients.
  
  
  METHODS
  We describe three cases of mesh erosion after TVT placement treated with laser excision of the eroded tape into the bladder. In one case, a 4 × 3 cm stone adhering to the mesh was present. The procedures were performed under spinal anesthesia. The polypropylene eroded mesh was mobilized with forceps to better expose the intramural portion of the sling, and it was disintegrated with holmium laser as close to the bladder mucosa as possible.
  
  
  RESULTS
  No complications were recorded. The patients were discharged after 24 h. In only one case, we had recurrent mesh exposure requiring a second procedure. After a mean follow-up of 15.3 months (range 12-20), the patients are asymptomatic with no evidence of tape erosion.
  
  
  CONCLUSIONS
  Intravesical mesh erosion can complicate sling procedure. Endoscopic holmium laser management is a useful treatment for mesh removal and stone lithotripsy. Repeated treatments are possible for the low morbidity and minimal invasiveness. A regular follow-up is necessary.
authors.affiliation: Urology O.U., Surgical Department, (Chief: P. Cortellini), University Hospital of Parma, Via Gramsci, 14, 43126, Parma, Italy, d.campobasso@virgilio.it.
authors.forename: Davide
authors.initials: D
authors.lastname: Campobasso
authors.forename: Dario
authors.initials: D
authors.lastname: Cerasi
authors.forename: Samanta
authors.initials: S
authors.lastname: Fornia
authors.forename: Silvia
authors.initials: S
authors.lastname: Meli
authors.forename: Stefania
authors.initials: S
authors.lastname: Ferretti
authors.forename: Pietro
authors.initials: P
authors.lastname: Cortellini
mesh_terms: D000368:Aged; D003558:Cystoscopy; D005260:Female; D006801:Humans; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D008875:Middle Aged; D011475:Prosthesis Failure / Q000009:adverse effects*; D053825:Suburethral Slings / Q000009:adverse effects*; D013526:Surgical Mesh / Q000009:adverse effects*; D001745:Urinary Bladder Diseases / Q000209:etiology / Q000601:surgery*