title: Holmium laser excision for urinary mesh erosion: a minimally invasive treatment with favorable long-term results.
abstract: OBJECTIVE
  Mesh erosion into the urinary tract following surgery for stress urinary incontinence is a potentially serious complication. Traditional open resection is complicated and potentially morbid. Therefore, we sought to evaluate the long-term patient outcomes following transurethral endoscopic excision using the holmium laser (TEEH).
  
  
  METHODS
  A retrospective series of ten patients who had undergone TEEH at our institution between May 2011 and July 2014 were identified. Nine had a prior urethral sling placed, and one had suture erosion following a Marshall-Marchetti-Krantz procedure. Outcomes assessed included resolution of symptoms, successful treatment of exposed mesh on repeat cystoscopy, and recurrence of stress urinary incontinence. Patients were followed up through office examination, cystoscopy and/or through written or telephone correspondence.
  
  
  RESULTS
  The median age of the patients at the time of surgery was 58 years (IQR 54 - 66 years). The median time from anti-incontinence surgery to onset of symptoms was 12 months (IQR 1 - 72 months). Patients with mesh erosion most commonly presented with irritative voiding symptoms (60%). The median follow-up was 27 months (IQR 14 - 32 months) with 80% of patients reporting symptomatic improvement. Eight patients underwent follow-up cystoscopy with anatomic success (resolution of erosion on cystoscopy) after one procedure in five patients (63%). The anatomic success rate was higher for bladder erosions than for urethral erosions (80% vs. 33%). Notably, three patients experienced recurrent stress urinary incontinence following TEEH, with one patient undergoing repeat anti-incontinence surgery.
  
  
  CONCLUSIONS
  TEEH is a viable, minimally invasive option for management of urinary mesh erosions. Notably, there is a risk of recurrent stress urinary incontinence following laser mesh excision.
authors.affiliation: Department of Urology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
authors.forename: Christina A
authors.initials: CA
authors.lastname: Ogle
authors.affiliation: Department of Urology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Linder
authors.affiliation: Department of Urology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA. elliott.daniel@mayo.edu.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Elliott
mesh_terms: D000368:Aged; D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery*; D012189:Retrospective Studies; D053825:Suburethral Slings / Q000009:adverse effects*; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000601:surgery*
keywords: Anti-incontinence; Complications; Laser; Mesh