THE EXPERIENCES OF TRANSURETHRAL ENDOSCOPIC EXCISION OF ERODED MESH USING HOLMIUM LASER CONSIDERING THE DEPTH OF EXCISION
SON, S. JANG, J. LEE, D. CHO;
Bundang Jesaeng Hosp., Seongnam, Korea, Republic of.
Introduction: Mesh erosion into the bladder is a troublesome complication following anti-incontinence surgery. Traditional transabdominal or transvaginal resection is complicated and potentially morbid. Therefore many surgeons have made efforts to develop minimal invasive endoscopic removal of eroded mesh(1-3). But, still we need to build up surgical experience and long term surgical outcomes.
Objective: We evaluated our surgical outcomes of transurethral endoscopic excision using the holmium laser (TEEH) for eroded mesh considering what is the important factor to prevent the recurrence of mesh erosion.
Methods: Total 9 TEEH were performed to remove the eroded mesh from Dec 2012 to Mar 2016. A retrospective review of 9 consecutive cases was done. For all cases, the review of recorded surgical footages was done. Outcome assessment was focused on follow-up cystoscopic findings, LUTS resolution and recurrence of SUI after mesh removal.
Results: For 6 patients, total 9 TEEH were performed. In all cases, follow-up cystoscopy was done within postop 6 months and every 1year thereafter. Three among the 6 patients underwent the second procedure for recurrent mesh erosion with/without stone. The recurrent cases were the initial three operations in this series which showed shallow excision of bladder layer in the surgical footage review(Fig. 1), (Table 1). Whereas, 6 subsequent operations in this series resulted no recurrence, which showed digging down to the deep detrusor or perivesical fat layer in the surgical footage review(Fig. 2), (Table 1).The mean age of patients at the Dx of mesh erosion was 59.6 yr(±8.9). The mean time from anti-incontinence surgery to the Dx of mesh erosion was 28.5 mo(±20.1).Mean follow-up after mesh removal was 19.6 mo(±11.2). Most of the cases(8/9) reported improvement of LUTS.
Conclusions: TEEH is a promising surgical option for management of mesh erosion which presents excellent symptomatic success and no recurrent SUI following operation. But, the frequent cystoscopy follow-up is mandatory, considering the recurrent erosion. To prevent the recurrent erosion after TEEH, the important surgical technique is digging down to the deep bladder layer to remove completely the mesh embedded in the bladder wall.
References: 1. Urology. 2009 Mar;73(3):681.e15-6. 2. Urol Case Rep. 2015 Apr 7;3(3):84-5. 3. Int Urogynecol J. 2015 Nov;26(11):1645-8.