Long-term results of transurethral endoscopic excision using the holmium laser for urethral perforation of synthetic slings

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Objective: This study reports on the long-term results of transurethral endoscopic excision using the Holmium laser (TEEH) for large urethral perforation (UP; defined as involving one-quarter or more of the urethral circumference) from synthetic slings. Methods: Charts of women treated with TEEH for large UP were reviewed. TEEH was performed using a 365-μm laser fiber passed inside an open-ended ureteral catheter positioned in a holmium laser enucleation of the prostate (HoLEP) sheath to stabilize the laser fiber. Data extracted included patient demographics, clinical presentations, surgical details, postoperative functional outcomes and complications, and any secondary repairs. Results: From 2011 to 2016, 12 women underwent TEEH. The mean interval between sling placement and first TEEH was 47 months (range 10–161 months). The types of slings included transvaginal tape (n = 2), transobturator tape (n = 4), mini-invasive (n = 4), and Solyx (1), or were not specified (n = 1). The mean number of TEEH procedures was 1.6 (range 1–3), and the mean length of initial treatment was 40 min (range 15–79 min), with subsequent treatments <30 min. Mean follow-up time was 43 months (range 14–70). Resolution of UP by TEEH alone was achieved in 6 patients, with 2 requiring multiple TEEH. Six patients underwent secondary vaginal mesh sling excision alone or with an associated repair including 2 small distal urethrovaginal fistulas. Conclusion: TEEH is a minimally invasive procedure that can avoid a more complex initial urethral reconstruction and should be considered for treating large UP. Secondary repairs for residual small UP or associated lower urinary tract symptomatology may be necessary and patients should be counseled accordingly.

Original languageEnglish (US)
Pages (from-to)O103-O110
JournalLUTS: Lower Urinary Tract Symptoms
Volume11
Issue number2
DOIs
StatePublished - Apr 1 2019

Fingerprint

Solid-State Lasers
Lasers
Suburethral Slings
Urinary Catheters
Urinary Tract
Fistula
Prostate
Demography

Keywords

  • endoscopic excision
  • holmium laser
  • mid-urethral slings
  • urethral perforation

ASJC Scopus subject areas

  • Neurology
  • Urology

Cite this

@article{142131df73c14f568f39d97a77242ae8,
title = "Long-term results of transurethral endoscopic excision using the holmium laser for urethral perforation of synthetic slings",
abstract = "Objective: This study reports on the long-term results of transurethral endoscopic excision using the Holmium laser (TEEH) for large urethral perforation (UP; defined as involving one-quarter or more of the urethral circumference) from synthetic slings. Methods: Charts of women treated with TEEH for large UP were reviewed. TEEH was performed using a 365-μm laser fiber passed inside an open-ended ureteral catheter positioned in a holmium laser enucleation of the prostate (HoLEP) sheath to stabilize the laser fiber. Data extracted included patient demographics, clinical presentations, surgical details, postoperative functional outcomes and complications, and any secondary repairs. Results: From 2011 to 2016, 12 women underwent TEEH. The mean interval between sling placement and first TEEH was 47 months (range 10–161 months). The types of slings included transvaginal tape (n = 2), transobturator tape (n = 4), mini-invasive (n = 4), and Solyx (1), or were not specified (n = 1). The mean number of TEEH procedures was 1.6 (range 1–3), and the mean length of initial treatment was 40 min (range 15–79 min), with subsequent treatments <30 min. Mean follow-up time was 43 months (range 14–70). Resolution of UP by TEEH alone was achieved in 6 patients, with 2 requiring multiple TEEH. Six patients underwent secondary vaginal mesh sling excision alone or with an associated repair including 2 small distal urethrovaginal fistulas. Conclusion: TEEH is a minimally invasive procedure that can avoid a more complex initial urethral reconstruction and should be considered for treating large UP. Secondary repairs for residual small UP or associated lower urinary tract symptomatology may be necessary and patients should be counseled accordingly.",
keywords = "endoscopic excision, holmium laser, mid-urethral slings, urethral perforation",
author = "Connie Wang and Zimmern, {Philippe E} and Lemack, {Gary E}",
year = "2019",
month = "4",
day = "1",
doi = "10.1111/luts.12226",
language = "English (US)",
volume = "11",
pages = "O103--O110",
journal = "LUTS: Lower Urinary Tract Symptoms",
issn = "1757-5664",
publisher = "Wiley Blackwell",
number = "2",

}

TY - JOUR

T1 - Long-term results of transurethral endoscopic excision using the holmium laser for urethral perforation of synthetic slings

AU - Wang, Connie

AU - Zimmern, Philippe E

AU - Lemack, Gary E

PY - 2019/4/1

Y1 - 2019/4/1

N2 - Objective: This study reports on the long-term results of transurethral endoscopic excision using the Holmium laser (TEEH) for large urethral perforation (UP; defined as involving one-quarter or more of the urethral circumference) from synthetic slings. Methods: Charts of women treated with TEEH for large UP were reviewed. TEEH was performed using a 365-μm laser fiber passed inside an open-ended ureteral catheter positioned in a holmium laser enucleation of the prostate (HoLEP) sheath to stabilize the laser fiber. Data extracted included patient demographics, clinical presentations, surgical details, postoperative functional outcomes and complications, and any secondary repairs. Results: From 2011 to 2016, 12 women underwent TEEH. The mean interval between sling placement and first TEEH was 47 months (range 10–161 months). The types of slings included transvaginal tape (n = 2), transobturator tape (n = 4), mini-invasive (n = 4), and Solyx (1), or were not specified (n = 1). The mean number of TEEH procedures was 1.6 (range 1–3), and the mean length of initial treatment was 40 min (range 15–79 min), with subsequent treatments <30 min. Mean follow-up time was 43 months (range 14–70). Resolution of UP by TEEH alone was achieved in 6 patients, with 2 requiring multiple TEEH. Six patients underwent secondary vaginal mesh sling excision alone or with an associated repair including 2 small distal urethrovaginal fistulas. Conclusion: TEEH is a minimally invasive procedure that can avoid a more complex initial urethral reconstruction and should be considered for treating large UP. Secondary repairs for residual small UP or associated lower urinary tract symptomatology may be necessary and patients should be counseled accordingly.

AB - Objective: This study reports on the long-term results of transurethral endoscopic excision using the Holmium laser (TEEH) for large urethral perforation (UP; defined as involving one-quarter or more of the urethral circumference) from synthetic slings. Methods: Charts of women treated with TEEH for large UP were reviewed. TEEH was performed using a 365-μm laser fiber passed inside an open-ended ureteral catheter positioned in a holmium laser enucleation of the prostate (HoLEP) sheath to stabilize the laser fiber. Data extracted included patient demographics, clinical presentations, surgical details, postoperative functional outcomes and complications, and any secondary repairs. Results: From 2011 to 2016, 12 women underwent TEEH. The mean interval between sling placement and first TEEH was 47 months (range 10–161 months). The types of slings included transvaginal tape (n = 2), transobturator tape (n = 4), mini-invasive (n = 4), and Solyx (1), or were not specified (n = 1). The mean number of TEEH procedures was 1.6 (range 1–3), and the mean length of initial treatment was 40 min (range 15–79 min), with subsequent treatments <30 min. Mean follow-up time was 43 months (range 14–70). Resolution of UP by TEEH alone was achieved in 6 patients, with 2 requiring multiple TEEH. Six patients underwent secondary vaginal mesh sling excision alone or with an associated repair including 2 small distal urethrovaginal fistulas. Conclusion: TEEH is a minimally invasive procedure that can avoid a more complex initial urethral reconstruction and should be considered for treating large UP. Secondary repairs for residual small UP or associated lower urinary tract symptomatology may be necessary and patients should be counseled accordingly.

KW - endoscopic excision

KW - holmium laser

KW - mid-urethral slings

KW - urethral perforation

UR - http://www.scopus.com/inward/record.url?scp=85064831736&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85064831736&partnerID=8YFLogxK

U2 - 10.1111/luts.12226

DO - 10.1111/luts.12226

M3 - Article

VL - 11

SP - O103-O110

JO - LUTS: Lower Urinary Tract Symptoms

JF - LUTS: Lower Urinary Tract Symptoms

SN - 1757-5664

IS - 2

ER -