Urinary Incontinence: Outcomes & Complications

Moderated Poster Session

MP3-20 - Long-term Outcomes of Holmium Laser Excision for Urinary Mesh Erosion

Thursday, September 20
4:00 PM - 6:00 PM
Location: Room 243

Introduction & Objective : Synthetic mesh placement for stress urinary incontinence (SUI) and pelvic organ prolapse (POP) have been popular treatment options.  Polypropylene mesh erosion into the bladder and/or urethra is a rare but serious complications that have been traditionally treated with transabdominal mesh excision with its inherent morbidity.  Transurethral endoscopic excision using the holmium laser (TEEH) is a potential treatment of genitourinary (GU) mesh erosion and has been reported in numerous small series with short term follow up.  We sought to evaluate long term patient outcomes following TEEH of foreign material after anti−incontinence surgery.  


Methods : We evaluated patients undergoing TEEH between 2011 and 2016. 24 patients underwent 30 TEEH excisions.   Of these, 18 had more than 6 months follow up. We assessed patient outcomes including resolution of presenting symptoms, treatment success on follow up cystoscopy, current QOL, and recurrence of SUI. Patient follow−up was obtained through office examination, cystoscopy and/or written or telephone correspondence.   


Results :

The median age at TEEH was 66 years (IQR 57;71). 89.9% of our cohort was female.  The median time from anti−incontinence surgery to onset of symptoms was 68 months (IQR 29;122). The most common presenting symptoms were hematuria and recurrent urinary tract infections (39%) although half of patients presented with multiple symptoms (50%).  Patients were found to have urethral erosion (55.5%) or bladder erosion (50.0%) with only one patient presenting with both (5.5%).  Median follow−up was 30 months (IQR 17;43) with 10/18 (56%) patients reporting symptomatic resolution.  Of patients with persistent symptoms, 83% noted significant improvement.  17 patients (94.4%) underwent follow−up cystoscopy at a median of 3 months (IQR 2;4) with 56.6% (10/18) were negative for recurrence.   In the eight patients with recurrence, five were asymptomatic.  5/18 (27.7%) required repeat TEEH.  Notably, four patients experienced recurrent SUI requiring repeat anti−incontinence surgery following TEEH (22.2%).


Conclusions :

TEEH is an acceptable alternative allowing select patients to avoid the morbidity of traditional transabdominal mesh excision.  TEEH successfully treats patients presenting symptoms with relatively low retreatment rate.  Roughly 20% of patients experienced SUI following TEEH requiring secondary anti-incontinence procedure.  This data should be utilized for patient counseling prior to TEEH.

Derek Gearman

Resident Physician
Mayo Clinic - Rochester

Chief Resident (PGY-5) - Mayo Clinic Department of Urology, Rochester, MN

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    Brian Linder

    Assistant Professor of Urology and OB/Gyn
    Mayo Clinic - Rochester

    Dr. Brian Linder, MD, MS is a Senior Associate Consultant at Mayo Clinic with a joint appointment as an Assistant Professor of Urology, and Obstetrics and Gynecology.

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      Daniel Elliott

      Professor of Urology
      Mayo Clinic - Rochester

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