Evaluating Non-ablative Erbium Yttrium Aluminium Garnet (YAG) Laser Treatment for Polypropylene Mesh-Induced Vaginal Erosion: A Case Series

Abstract

Background Vaginal erosion caused by the polypropylene mesh is a serious side effect, and the development of effective treatment methods is required. This study explored the potential of non-ablative vaginal erbium yttrium aluminum garnet (YAG) laser treatment (VEL) as a novel treatment approach. Methods In this study, VEL was performed on nine women who experienced vaginal erosion after undergoing treatment for pelvic organ prolapse (POP) with polypropylene mesh. These patients visited our hospital between April and December 2020. Using the Renovalase (SP Dynamis Fotona d.o.o., Ljubljana, Slovenia), the laser was applied to the entire vagina, with intensive irradiation focused on the erosion areas. Detailed analyses of symptoms before and after treatment, as well as histopathological changes, were conducted one year post-treatment. Results Nine women were referred to our hospital due to vaginal erosion caused by polypropylene mesh. The participants' average age was 73.2 years (range: 69-81 years), with four patients having undergone transvaginal mesh (TVM) surgery and five undergoing laparoscopic sacrocolpopexy (LSC). The average time from mesh insertion to treatment initiation was 7.2 years (range: 3-15 years), with eight patients having previously attempted mesh removal. Post-treatment, significant improvements were observed in managing vaginal erosion and related bleeding, corroborated by histopathological analysis confirming cell regeneration and tissue repair. These improvements also resulted in significant improvements in bleeding management and quality of life (QoL). Conclusion VEL suggests the possibility of being an effective treatment method for vaginal erosion caused by a polypropylene mesh. However, further research is needed because of the small sample size and the limitations inherent in the retrospective case series design.

Pathological Insights on Polypropylene Mesh Complications From Laparoscopic Sacrocolpopexy: A Case Series

“…VEL and targeted laser irradiation have been histopathologically proven to effectively manage vaginal erosion and associated bleeding in previous study [26]. The results of the present study corroborate these findings, highlighting the potential of VEL and targeted laser irradiation as novel treatment options for vaginal erosion and bleeding after mesh removal.…”

“…This study, leveraging our past experiences [13,[25][26][27], contributed to symptom alleviation in all patients without immediate mesh insertion.…”

“…Patients with stress urinary incontinence were presented with two options: adding TVT surgery during the vNOTES procedure or improving urinary incontinence without adding TVT through vaginal and urethral non-ablation erbium YAG laser (VEL + UEL) treatment [25]. If normalization of the vaginal mucosa was slow after surgery and erosion and bleeding persisted, VEL (Vaginal Erbium Laser) treatment was proposed [26]. Patients with fecal incontinence were offered two choices: receiving guidance on pelvic floor muscle exercises or improving fecal incontinence without additional surgery through vaginal and anal nonablative Erbium YAG laser and Neodymium YAG laser (VEL + AEL + Nd:YAG) treatment [27].…”

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

“…However, surgical targets and criteria have not been clarified [8]. Vaginal erbium laser (VEL) treatment has gained attention as a minimally invasive treatment option [11,12]. VEL uses laser technology to promote collagen regeneration in the vaginal and urethral mucosa, thereby improving SUI and OAB symptoms [11,12].…”

“…Vaginal erbium laser (VEL) treatment has gained attention as a minimally invasive treatment option [11,12]. VEL uses laser technology to promote collagen regeneration in the vaginal and urethral mucosa, thereby improving SUI and OAB symptoms [11,12]. VEL is noninvasive, has a low risk of complications, and is applicable to patients who desire pregnancy [2].…”