Analyzing the Histological Effects of Laser Therapy in Alleviating Discomfort Post Mid-Urethral Sling Removal: A Case Study and Review

Nobuo Okui, C. Tamer Erel, Machiko A Okui, Adolf Lukanovic
Pages: onlineFirst

Stress Urinary Incontinence (SUI) impacts many adult women and is commonly addressed with mid-urethral sling (MUS) surgery. Despite its effectiveness, this surgery can lead to complications and discomfort, sometimes necessitating the removal of the MUS. This case report discusses a 55-year-old woman who underwent TFS (Urethral Central Tissue Fixation System) insertion to treat SUI and uterine prolapse. The patient, suffering from significant pain post-insertion, underwent TFS removal via vaginal laparoscopy. The removal significantly alleviated her pain. Following this, non-ablative Er:YAG SMOOTH® laser therapy (VEL and UEL) was proposed and administered. The laser treatment significantly reduced pain (VAS score from 10 to 0) and urinary leakage (1-hour pad test from 102g to 1g at one year post-treatment), resulting in a long-term positive outcome. Additionally, persistent posterior vaginal fornix bleeding, which continued after the TFS removal, ceased following the laser therapy. Pathological analysis of mid-urethral vaginal area biopsies post-laser therapy revealed expansion of healthy mucosal epithelium, absence of cysts and multinucleated giant cells, suggesting tissue regeneration and normalization. This case underscores the potential of Er:YAG laser therapy as a viable option for managing complications following MUS removal. It emphasizes the need for further research and exploration in this area, along with a comprehensive review of the relevant literature.

Key words: mid-urethral sling, laser therapy, stress urinary incontinence, mesh extraction, pain, complications.

Analyzing the Histological Effects of Laser Therapy in Alleviating Discomfort Post Mid-Urethral Sling Removal: A Case Study and Review