Minimally Invasive Removal of Intravesical Polypropylene Tension-Free Vaginal Tape Using Holmium Laser

Keller N1, Haemmerle B2, Lothaller C3, Schmid S2, Scheiner D4, Betschart C5

Research Type

Clinical

Abstract Category

Female Lower Urinary Tract Symptoms (LUTS) / Voiding Dysfunction

Abstract 879
Non Discussion Video
Scientific Non Discussion Video Session 200
Female Infection, Urinary Tract Pain, other Overactive Bladder Surgery
1. Department of Gynecology, University Hospital Zurich; University of Zurich, Hospital Grabs, Switzerland, 2. Department of Gynecology, Hospital Grabs, Switzerland, 3. Department of Gynecology, University Hospital Zurich, University of Zurich, Switzerland, 4. Department of Gynecology University hospital Zurich, University of Zurich, Blasenzentrum, Switzerland, 5. Department of Gynecology University Hospital Zurich, University of Zurich, Switzerland
Links

Abstract

Introduction 
Intravesical or intraurethral penetration following the insertion of midurethral polypropylene slings for the treatment of stress urinary incontinence (SUI) is a late complication. According to the IUGA/ICS Prosthesis/Graft Complication Classification, complications occurring more than 12 months postoperatively are categorized as 4BeT4S2. Such complications can cause unexpected symptoms, including bladder or urethral lithiasis, pain, recurrent infections, or obstructed micturition. The removal of the exposed tape is usually indicated. A minimally invasive technique with a short hospital stay could offer significant benefits to patients.
Design 
This video demonstrates a minimally invasive surgical technique for the transurethral holmium:YAG laser vaporization of polypropylene tape at various locations in the lower urinary tract. (laser setting: energy 1.5 Jo, 14 Hz, effect 100, coagulation 0.6J). The video demonstrates images of five female patients.
Results 
After laser application to the tape and its fibers at the site of penetration, follow-up cystoscopy confirmed urothelial overgrowth, indicating successful lesion healing. No complications, such as gross hematuria or fistula formation, occurred. Mean operation time is 45 minutes (range 30min – 90min).
Conclusion 
In our experience, this minimally invasive procedure achieves favorable postoperative outcomes and effectively resolves preoperative lower urinary tract symptoms. In one case, recurrent SUI required a laparoscopic Burch colposuspension during follow-up. Compared to laparoscopic or open tape excision with cystotomy or urethrotomy, the transurethral approach results in significantly less tissue damage and a smaller wound area, leading to faster patient recovery. In a 2024 systematic review of 138 patients who underwent transurethral laser treatment for mesh erosion, complete resolution was achieved in 88 patients (63.7%), while 32 patients (23.2%) experienced persistent or recurrent SUI, and 17 patients (12.3%) required a second or third laser treatment due to recurrent mesh erosion; the median follow-up was 23.6 months. Our findings support transurethral Holmium:YAG laser vaporization as a safe, effective, and minimally invasive treatment option for intravesical or intraurethral polypropylene tape penetration, offering reduced tissue trauma, faster recovery, and favorable long-term outcomes.
References 
  1. Ripa F, Enikeev D, Talyshinskii A, Juliebø-Jones P, Tzelves L, Kallidonis P, Somani B. Should endoscopic laser excision be offered as the first-line management for patients with eroded mesh? Outcomes of a systematic review of literature. Curr Opin Urol. 2024 Mar 1;34(2):135-144. doi: 10.1097/MOU.0000000000001146. Epub 2023 Nov 6. PMID: 37933676.
Disclosures
Funding none Clinical Trial No Subjects Human Ethics not Req'd This is not necessary, as the laser method is already established for other indications in the urinary tract Helsinki Yes Informed Consent Yes AI For simple textual assistance in writing the abstract manuscript
07/06/2026 02:43:43