The Potential of Non-ablative Erbium (YAG) Laser Treatment for Complications After Midurethral Sling Surgery: A Narrative Review

Abstract

Midurethral sling (MUS) surgery, using tension-free vaginal tape and transobturator tape, has been widely adopted for the treatment of stress urinary incontinence (SUI). However, postoperative complications, including persistent urinary incontinence, mesh exposure, and pain, have become problematic, and surgical treatments for these complications face challenges, such as invasiveness, treatment-resistant cases, and recurrence. This review provides an overview of the current evidence regarding these complications and the potential of vaginal non-ablative erbium (YAG) laser (VEL) treatment as a minimally invasive option with low risk of complications. Studies have suggested the effectiveness of VEL treatment, performed using devices such as IncontiLase (SP Dynamis; Fotona d.o.o., Ljubljana, Slovenia), for persistent urinary incontinence after MUS surgery, pain following mesh removal, and asymptomatic mesh exposure. VEL treatment is expected to be a new treatment option for complications following MUS surgery; however, further large-scale comparative trials are required to verify its efficacy and safety and to establish criteria for its indications. Appropriate assessment of the indications and provision of sufficient information to patients is important when presenting VEL as a treatment option.

The Treatment Selection for a 36-Year-Old Woman With Stress Urinary Incontinence Using a Discrete Mathematical Approach: A Case Report

“…The gold standard for stress urinary incontinence (UI) that is unresponsive to pelvic floor muscle training is MUS, represented by TVT and TOT [5,[8][9][10][11][12][13][14][15][16][17][18][19][20]. MUS has a high success rate and abundant evidence for SUI; however, although the complication rate is low, pain may occur with TVT [7][8][9][10][11][12][13][14][15][16][17][18][19][20]. If many patients experience anxiety, it is an important issue, even if the complication rate is low, because healthcare should be patient-centered [2,21].…”

“…If many patients experience anxiety, it is an important issue, even if the complication rate is low, because healthcare should be patient-centered [2,21]. Moreover, if pain occurs after MUS treatment, removal of the polypropylene mesh is not easy, and the tissue may not return to its original state [7,11,12]. In recent years, VEL has emerged [7].…”

“…Moreover, if pain occurs after MUS treatment, removal of the polypropylene mesh is not easy, and the tissue may not return to its original state [7,11,12]. In recent years, VEL has emerged [7]. VEL has a shorter history than TVT, and there are few randomized controlled trials (RCTs) [7].…”

“…In recent years, VEL has emerged [7]. VEL has a shorter history than TVT, and there are few randomized controlled trials (RCTs) [7]. Comparative studies between TVT and VEL are scarce, including RCTs and retrospective studies [21].…”

“…Tension-free vaginal tape (TVT), a representative MUS technique, has been reported to have high efficacy and low complication rates [5]. TVT is an invasive surgery with risks of complications such as postoperative pain and voiding dysfunction [6,7]. Japanese guidelines recommend MUS for patients with simultaneous SUI and OAB based on evidence [8][9][10].…”