Kubilay SARIKAYA, Çağri ŞENOCAK, Muhammed Arif İBİŞ, Fahri Erkan SADİOĞLU, Mehmet ÇİFTÇİ, Ömer Faruk BOZKURT

The effectiveness of concomitant intravaginal laser treatment in patients undergoing mesh excision due to vaginal exposure or extrusion

Objective: To investigate the efficacy of intravaginal laser therapy applied concurrently with mesh excision for the treatment of vaginal polypropylene mesh exposure or extrusion, which is the most common complication after transobturator tape (TOT), on the recurrence of incontinence. Material and Method: The data of 49 patients who underwent mesh excision due to vaginal mesh exposure or extrusion in our clinic between January 2009 and January 2020 were retrospectively analyzed. The patients were divided into two groups as simultaneous intravaginal laser therapy during the mesh excision (EL, n=23) and only mesh excision (EO, n=26). Data of the patients and long-term stress urinary incontinence (SUI) recurrence rates were determined and the groups were compared. Results: The mean age of the patients was 50.4±9.9 years and the mean follow-up period was 33.3±22.1 months. SUI recurrence in 1-h pad test was significantly lower in the EL group than the EO group at the 12 th month evaluation (8.7% vs 34.6% p=0.030 respectively). According to multivariate regression analysis operation type was an independent risk factor for SUI recurrence (p=0.021). However, there was no significant difference between the groups in terms of postoperative incontinence quality of life questionnaire (I-QOL) scores (p=0.082). Conclusion: Concomitant laser treatment applied with the mesh excision for the treatment of vaginal meshexposure or extrusion secondary to TOT surgery provides a significant advantage in preventing the recurrence of SUI.

Keywords:

Laser therapy, mesh erosion, incontinence recurrence,

PDF

___

Takahashi S, Takei M, Nishizawa O, et al. Clinical guidelines for female lower urinary tract symptoms. Tokyo: The Neurogenic Bladder Society; 2013: 6–168.
Jarvis GJ. Surgery for genuine stress incontinence. Br J Obstet Gynaecol 1994; 101: 371–4.
Henriksson L, Ulmsten U. A urodynamic evaluation of the effects of abdominal urethrocystopexy and vaginal sling urethroplasty in women with stress incontinence. Am J Obstet Gynecol 1978; 131: 77–82.
Keršič M, Keršič M, Kunič T, et al. Single-incision mini-sling for the treatment of female stress urinary incontinence: is it actually inferior to transobturator vaginal tape and tension-free vaginal tape? Gynecol Minim Invasive Ther 2020; 9: 123-30.
Kenton K, Stoddard AM, Zyczynski H, et al. 5-year longitudinal follow-up after retropubic and transobturator midurethral slings the urinary incontinence treatment network. J Urol 2015; 193: 203–10.
Ramart P, Ackerman AL, Cohen SA, Kim JH, Raz S. The risk of recurrent urinary incontinence requiring surgery after suburethral sling removal for mesh complications. Urology 2017; 106: 203-9.
Fistonić N.Fistonić I.Guštek Š.F et al.Minimally invasive, non-ablative Er:YAG laser treatment of stress urinary incontinence in women–a pilot study.Lasers Med Sci 2016; 31: 635-43.
Pardo J, Sola VR, Morale AA. Treatment of female stress urinary incontinence with Erbium-YAG laser in non-ablative mode. Eur J Obstet Gynecol Reprod Biol 2016; 204: 1-4.
Swift S. Current opinion on the classification and definition of genital tract prolapse. Curr Opin Obstet Gynecol 2002; 14: 503-7.
Orgensen L, Lose G, Anders J. One-hour pad weighing test for objective assessment of female incontinence. Obstet Gynecol 1987; 69: 39-43.
Eyigor S, Karapolat H, Akkoc Y, Yesil H, Ekmekci O. Quality of life in patients with multiple sclerosis and urinary disorders: reliability and validity of Turkish-language version of Incontinence Quality of Life Scale. J Rehabil Res Dev 2010; 47: 67-71.
Burkhard FC, Bosch JLHR, Cruz F et al. EAU Guidelines. Edn. presented at the EAU Annual Congress Copenhagen 2018. ISBN 978-94-92671-01-1. 2018.
Niknejad K, Plzak LS, 3rd, Staskin DR, Loughlin KR. Autologous and synthetic urethral slings for female incontinence. Urol Clin North Am 2002; 29: 597-611.
Gomes CM, Carvalho FL, Bellucci CHS, et al. Update on complications of synthetic suburethral slings. Int Braz J Urol. 2017; 43: 822-34.
Berger AA, Tan-Kim J, Menefee SA. Long-term risk of reoperation after synthetic mesh midurethral sling surgery for stress urinary incontinence. Obstet Gynecol 2019; 134: 1047-55.
Welk B, Al-Hothi H, Winick-Ng J. Removal or revision of vaginal mesh used for the treatment of stress urinary incontinence. JAMA Surg 2015; 150: 1167-75.
Ismail S, Chartier-Kastler E, Reus C, Cohen J, Seisen T, Phé V. Functional outcomes of synthetic tape and mesh revision surgeries: a monocentric experience. Int Urogynecol J 2019; 30: 805-13.
Shaw J, Wohlrab K, Rardin C. Recurrence of stress urinary incontinence after midurethral sling revision: a retrospective cohort study. Female Pelvic Med Reconstr Surg 2017; 23: 184-7.
Bakali E, Johnson E, Buckley BS, Hilton P, Walker B, Tincello DG. Interventions for treating recurrent stress urinary incontinence after failed minimally invasive synthetic midurethral tape surgery in women. Cochrane Database Syst Rev 2019; 4: 9.
Yoshizawa T, Yamaguchi K, Obinata D, et al. Laparoscopic transvesical removal of erosive mesh after transobturator tape procedure. Int J Urol 2011; 18: 861–3.
Han L, Wang L, Wang Q, Li H, Zang H. Association between pelvic organ prolapse and stress urinary incontinence with collagen. Exp Ther Med 2014; 7: 1337–41.
El-Domyati M, Abd-El-Raheem T, Medhat W, Abdel-Wahab H, Anwer MA. Multiple fractional erbium: yttrium-aluminum-garnet laser sessions for upper facial rejuvenation: clinical and histological implications and expectations. J Cosmet Dermatol 2014;13: 30–7.
Okui N. Comparison between erbium-doped yttrium aluminum garnet laser therapy and sling procedures in the treatment of stress and mixed urinary incontinence. World J Urol 2019; 37: 885-9.
Blaganje M, Šćepanović D, Žgur L, Verdenik I, Pajk F, Lukanović A. Non-ablative Er:YAG laser therapy effect on stress urinary incontinence related to quality of life and sexual function: A randomized controlled trial. Eur J Obstet Gynecol Reprod Biol 2018; 224: 153-8.
Kuszka A, Gamper M, Walser C, Kociszewski J, Viereck V. Erbium:YAG laser treatment of female stress urinary incontinence: midterm data. Int Urogynecol J 2020; 31: 1859-66.
Erel CT, Inan D, Mut A. Predictive factors for the efficacy of Er:YAG laser treatment of urinary incontinence. Maturitas 2020; 132: 1-6.
Ogrinc UB, Senčar S, Lenasi H. Novel, minimally invasive laser treatment of urinary incontinence in women. Lasers Surg Med 2015; 47: 689–97.