Mesh related complications from mid-urethral sling and transvaginal mesh prolapse surgeries are uncommon but often can be devastating. Previous initial treatments required major reconstruction with prolonged hospital stay and repeated surgeries following mesh removal. To maximise outcomes and minimise morbidity we describe our cohort series of women treated by endoscopic Holmium laser (HL) for these events in a tertiary referral centre.

A prospective review of consecutive patients from an IRB approved mesh complications database was performed. Patients with symptomatic mesh erosions from synthetic sling and prolapse surgery identified on vaginoscopy and or cystoscopy who were treated endoscopically with Holmium were analyzed. Data assessed included demographic characteristics, prior anti-incontinence/ genitourinary surgery, clinical presentations, complications, validated questionnaires, POP-Q examination and associated outcomes.

Twenty-three patients were identified with mesh erosions treated with the HL from October 2011 to November 2019 with at least 6 months follow up.  Seventeen (74%)  were related to urethral erosion and 6 (26%) were related to bladder erosion. Mean age and median follow-up were 59 years (45-79) and 29.7 months (6-108.7) respectively. Types of slings included transvaginal tape (n = 8), transobturator tape (n = 3), mini-invasive (n = 4), and transvaginal mesh (n=2), or were not specified (n = 6). The mean number of HL procedures was 2 (range 1-5), and the mean operative time was 54.4 min (range 15-130 min) with subsequent treatments were <30 min. Resolution defined as ‘no significant residual mesh at follow up cystoscopy ‘was achieved in 21 patients (91.3%), with 2 unsuccessful. Eleven patients required further operative treatments including secondary vaginal mesh sling excisions, distal urethrovaginal fistulas repairs, anti-incontinence surgeries and fulguration. Functional postoperative scores were QoL of 4.8 (range 1-10), UDI-6 of 7.8 (range 1-12), and IIQ-7 of 7 (range 0-18).

Holmium laser for treatment of large surface areas of mesh erosions negates potential requirement for more morbid reconstructive procedures from the outset. However, retreatments are common and often functional outcomes are persistent and secondary corrective surgeries are required in an attempt to resolve patient symptoms.

Holmium is a minimally invasive procedure that can  treat mesh erosions that can save patients more complicated surgeries from the outset . However multiple treatments are required to completely remove eroded mesh with high success  and  this allows for further planning and definitive treatments in a stage fashioned. At least half of the patients in our cohort required further procedures  for persistent symptoms and patients should be counseled accordingly.