Abstract
Objective: To investigate the efficacy of intravaginal laser therapy applied concurrently with mesh excision for the treatment of vaginal polypropylene mesh exposure or extrusion, which is the most common complication after transobturator tape (TOT), on the recurrence of incontinence.
 Material and Method: The data of 49 patients who underwent mesh excision due to vaginal mesh exposure or extrusion in our clinic between January 2009 and January 2020 were retrospectively analyzed. The patients were divided into two groups as simultaneous intravaginal laser therapy during the mesh excision (EL, n=23) and only mesh excision (EO, n=26). Data of the patients and long-term stress urinary incontinence (SUI) recurrence rates were determined and the groups were compared.
 Results: The mean age of the patients was 50.4±9.9 years and the mean follow-up period was 33.3±22.1 months. SUI recurrence in 1-h pad test was significantly lower in the EL group than the EO group at the 12 th month evaluation (8.7% vs 34.6% p=0.030 respectively). According to multivariate regression analysis operation type was an independent risk factor for SUI recurrence (p=0.021). However, there was no significant difference between the groups in terms of postoperative incontinence quality of life questionnaire (I-QOL) scores (p=0.082).
 Conclusion: Concomitant laser treatment applied with the mesh excision for the treatment of vaginal meshexposure or extrusion secondary to TOT surgery provides a significant advantage in preventing the recurrence of SUI.
Highlights
Stress urinary incontinence (SUI) is involuntary incontinence caused by increased intra-abdominal pressure such as coughing, laughing, and weight lifting that affects approximately 45-50% of women [1]
More minimally invasive and applicable laser therapy methods have been used in the treatment of stress urinary incontinence (SUI) in order to reduce the complications of sling materials, and success rates comparable to midurethral sling procedures have been reported [7,8]
Similar to the literature data, in our study, there was no significant difference between the groups in terms of SUI rates in 1-h pad test in the preoperative period, but the SUI recurrence was significantly higher in the excision only (EO) group than in the EL group
Summary
Stress urinary incontinence (SUI) is involuntary incontinence caused by increased intra-abdominal pressure such as coughing, laughing, and weight lifting that affects approximately 45-50% of women [1]. Mid-urethral sling procedures and minimally invasive methods have become the first choice in the surgical treatment of SUI due to their many advantages such as easy application, cost effective, short learning curve, short operation time and high success rates [3].Despite the many advantages that mid-urethral sling procedures provide, polypropylene mesh (PPM) exposure or extrusion, which is reported to be approximately 3.8-15 %, is the most common complication of these surgeries [4]. More minimally invasive and applicable laser therapy methods have been used in the treatment of SUI in order to reduce the complications of sling materials, and success rates comparable to midurethral sling procedures have been reported [7,8]. Laser applications are used as the primary treatment method in SUI, there is not enough data in the literature regarding the efficacy of laser treatments applied simultaneously with the mesh removal operation
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