Endoscopic holmium laser excision of intravesical tension-free vaginal tape and polypropylene suture after anti-incontinence procedures.

Abstract

We report on our technique of endoscopic excision of intravesical tension-free vaginal tape procedure and polypropylene sutures using the holmium laser following various anti-incontinence procedures. Three patients who previously underwent the tension-free vaginal tape, Burch colposuspension and Stamey vesicopexy, respectively, presented with a range of symptoms including hematuria, recurrent urinary tract infection, frequency, urgency and urinary incontinence. Patients were evaluated with history and examination, and all 3 were found to have nonabsorbable intravesical material. There was obvious encrustation over the eroded polypropylene material within the bladder. A 365 microm tip firing holmium laser fiber was inserted through the working channel of the flexible cystoscope. The tape and sutures were successfully excised using a holmium laser output of 1.0 J per pulse at a rate of 10 Hz. Mean operative time was 15 minutes. Holmium laser excision of intravesical polypropylene tape or suture is a minimally invasive solution to the problem of intravesical perforation or erosion following anti-incontinence procedures.