Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9110, USA.
Urologic Surgery, University of Kansas Medical Center, 4000 Cambridge Street, Kansas City, KS, 66160, USA.
World J Urol. 2024 Mar 9;42(1):125. doi: 10.1007/s00345-024-04822-8.
To review our 10-year experience with laser excision for urethral mesh erosion (UME) of mid-urethral slings (MUS).
Following Institutional Review Board approval, the charts of female patients with endoscopic laser excision of UME were retrospectively reviewed. Demographics, clinical presentation, surgical history, pre- and post-operative Urinary Distress Inventory-6 scores and quality of life ratings, operative reports, and outcomes were obtained from electronic medical records. UME cure was defined as no residual mesh on office cystourethroscopy 5-6 months after the final laser excision procedure.
From 2011 to 2021, 23 patients met study criteria; median age was 56 (range 44-79) years. Twenty (87%) had multiple prior urogynecologic procedures. Median time from MUS placement to presentation with UME-related complaints was 5.3 [interquartile range (IQR) 2.3-7.6] years. The most common presenting symptom was recurrent urinary tract infection (rUTI) (n = 10). Median operating time was 49 (IQR 37-80) minutes. Median duration of follow-up was 24 (IQR 12-84) months. Fourteen (61%) required more than 1 laser excision procedure for UME. Although 5 were asymptomatic (22%), new (n = 5) or persistent (n = 8) urinary incontinence was the most common symptom on follow-up (57%).
UME presenting symptoms are highly variable, necessitating a high index of suspicion in patients with a history of MUS, especially in the case of rUTI. Endoscopic laser excision is a minimally invasive, brief, safe, outpatient procedure with a high UME cure rate.
回顾我们在使用激光切除尿道中段吊带（MUS）所致尿道网片侵蚀（UME）方面的 10 年经验。
在获得机构审查委员会批准后，对接受内镜激光切除 UME 的女性患者的病历进行了回顾性分析。从电子病历中获取了人口统计学资料、临床表现、手术史、术前和术后尿困扰量表 6 分（Urinary Distress Inventory-6 score）和生活质量评分、手术报告和结果。在最后一次激光切除 5-6 个月后，在局麻膀胱尿道镜下未见残余网片定义为 UME 治愈。
2011 年至 2021 年，共有 23 名患者符合研究标准；中位年龄为 56 岁（范围 44-79 岁）。20 例（87%）有多种既往妇科泌尿手术史。从 MUS 放置到出现与 UME 相关症状的中位时间为 5.3 年（四分位距 [IQR] 2.3-7.6）。最常见的首发症状是复发性尿路感染（rUTI）（n=10）。中位手术时间为 49 分钟（IQR 37-80）。中位随访时间为 24 个月（IQR 12-84）。14 例（61%）需要多次激光切除才能治愈 UME。尽管有 5 例无症状（22%），但在随访时最常见的症状是新发（n=5）或持续存在的（n=8）尿失禁（57%）。
UME 的首发症状多种多样，因此对于有 MUS 病史的患者，特别是在 rUTI 的情况下，需要高度怀疑 UME 的可能性。内镜激光切除是一种微创、短暂、安全的门诊手术，UME 治愈率高。
