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

Nobuo Okui; Yuko Kouno; Kaori Nakano; Machiko A Okui

doi:10.7759/cureus.55128

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

Cureus. 2024 Feb 28;16(2):e55128. doi: 10.7759/cureus.55128. eCollection 2024 Feb.

Authors

Nobuo Okui¹, Yuko Kouno², Kaori Nakano², Machiko A Okui³

Affiliations

¹ Dentistry, Kanagawa Dental University, Kanagawa, JPN.
² Urology, Dr. Okui's Urogynecology and Urology, Yokosuka, JPN.
³ Urogynecology, Yokosuka Urogynecology and Urology Clinic, Kanagawa, JPN.

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.

Keywords: laparoscopic sacrocolpopexy; non-ablative erbium: yttrium-aluminum-garnet laser treatment; pelvic organ prolapse; polypropylene mesh; transvaginal mesh; vaginal erosion.