Suprapubic mini-laparoscopy-assisted transurethral thulium laser excision of intravesical mesh after anti-incontinence sling procedures

Objectives: We present our innovative technique of excising intravesically exposed mesh resulting from anti-incontinence sling procedures using transurethral thulium laser assisted by a suprapubic transvesical mini-laparoscopic grasper. Methods: Two patients agreed to anti-incontinence sling surgery for stress urinary incontinence several years ago prior to presentation. Because of symptom recurrence, they underwent repeat anti-incontinence sling surgery. One patient developed dysuria and mild lower abdominal pain gradually 1 month after the operation. Cystoscopy was performed and revealed exposed mesh at the left anterolateral wall, which might have resulted from missed intraoperative bladder perforation. The other patient presented with dysuria 2 years following the second sling procedure. Cystoscopy demonstrated a calcified mass attached to the right lateral wall. Bladder erosion by a previously implanted mesh was thought to be the cause. Intravesical mesh was removed transurethrally with thulium laser assisted by a suprapubic transvesical mini-laparoscopic grasper for the former patient. Vesicolithotripsy was performed for the latter patient first and the intravesical mesh was removed in the same manner as in the former patient. Results: The intravesical mesh was removed smoothly with thulium laser with the assistance of a suprapubic mini-laparoscopic grasper. As the procedure was minimally invasive, both patients recovered well after removal of the intravesical mesh. The irritative voiding symptoms also subsided following removal of the mesh. Conclusion: Removal of eroded or misplaced intravesical mesh after anti-incontinence sling procedures can be accomplished by transurethral laser excision with the assistance of suprapubic transvesical mini-laparoscopic instruments. The procedure is safe, effective, and minimally invasive, with a fast recovery.