Endoscopic Removal Of Intravesical Polypropylene Sling With The Holmium Laser.

Three women were referred following SPARC slingplasty for stress incontinence performed elsewhere. The presenting complaint was either hematuria alone, stress incontinence alone, or hematuria and stress incontinence following the SPARC sling procedure. The patients presented at 1, 2 and 6 months after the procedures. On examination cystoscopy revealed the synthetic sling coursing through the entire bladder in 2 patients and partially through the bladder neck in 1. Cystoscopy with holmium laser ablation of the intravesical sling was performed. Flexible cystoscopy and a variety of lens angles with rigid cystoscopy were used. Laser settings of 0.5 to 8 J at 5 to 20 Hz were used to divide the mesh at its entrance and exit (fig. 1). For the bladder neck mesh the Lone Star Retractor system (Lone Star Medical Products, Inc., Stafford, Texas) was used to stabilize the urethra. In all cases the laser was used to ablate the mesh slightly deeper than mucosa to allow the mucosa to grow over the puncture sites (fig. 2). The mesh tape was pulled out of the bladder with graspers. No bladder perforations occurred. A Foley catheter was placed in all cases. At 1 month postoperatively repeat cystoscopy was performed with the puncture sites re-epithelialized. No mesh was visualized. Two patients underwent repeat SPARC slingplasty for stress incontinence. The patient who presented with only hematuria did not have development of recurrent stress incontinence.