case_images: PMC10758587_01
case_images: MUS removal surgery procedure (Case 1). a. Assessment of pain location (white arrows) before applying anesthesia. b. After lumbar or general anesthesia, an incision is made into the painful vaginal mucosa and the vaginal wall is peeled to expose the mesh (gray arrow). c. The extracted mesh.
case_images: cureus-0016-00000051431-i01.jpg
case_images: PMC10758587_05_cureus-0016-00000051431-i01.jpg
case_images: FIG1
case_images: Figures 12a and 12b show M1, in which a large vacuolization (Va) is observed in the area where the mesh was inserted, and a large number of foreign-body giant cells (black arrows) are observed.
case_images: VEL + UEL treatment procedure. a. SP Dynamis; Copyright   2013. Provided courtesy of Fotona d.o.o. (Ljubljana, Slovenia). This image in Figure 2a is provided free of charge by Fotona d.o.o. b. 1, Special glass speculum for laser; 2, PS03 laser probe for the anterior wall of the vagina; 3, R11 laser probe for the entire circumference of the vagina; 4, R09-2Gu laser probe for the entire circumference of the urethra. c. VEL step (glass speculum insertion). d. VEL step (laser irradiation of anterior vaginal wall by PS03). e. VEL step (whole vaginal laser irradiation by R11). f. UEL step (whole urethral laser irradiation with R09-2Gu).
case_images: cureus-0016-00000051431-i02.jpg
case_images: PMC10758587_01_cureus-0016-00000051431-i02.jpg
case_images: FIG2
case_images: Laser irradiation was performed with Renovalase (SP Dynamis Fotona d.o.o, Ljubljana, Slovenia, Figure 2a), starting with VEL and proceeding to UEL. The prepared devices included a special glass vaginal speculum dedicated to the laser probes PS03, R11, and R09-2 Gu, as well as handpieces (Figure 2b for PS03, R11, and R09-2 Gu). In the VEL step, the glass speculum was inserted into the vagina (Figure 2c), and the anterior vaginal wall was scanned with a PS03 laser probe with a spot size of 7 mm, pulse fluence of 6 J/cm2, and frequency of 2.0 Hz (Figure 2d). This treatment utilized a spot size of 7 mm, a pulse fluence of 3.00 J/cm2, and a frequency of 2.0 Hz (Figure 2e). The laser treatment settings were R09-2 Gu, SMOOTH, 1.4 Hz, 1.5 J/cm2, and four stacks from the urethral meatus to the proximal end in 2.5 mm increments (Figure 2f).
case_images: Overall course of pain and SUI in Case 1. Left vertical axis: degree of pain (VAS), right vertical axis: one-hour pad test, horizontal axis: time, black circles: VAS, gray bars: one-hour pad test. SUI: stress urinary incontinence, VAS: visual analog scale pain score (0: no pain to 10: greatest pain), T0: first visit, M1: first mid-urethral sling (MUS) removal surgery, M-T1: 1 year after MUS removal surgery, L1: first laser treatment, L2: second laser treatment, L3: third laser treatment, L-T1: one year after the third laser treatment (L3).
case_images: cureus-0016-00000051431-i03.jpg
case_images: PMC10758587_01_cureus-0016-00000051431-i03.jpg
case_images: FIG3
case_images: The prepared devices included a special glass vaginal speculum dedicated to the laser probes PS03, R11, and R09-2 Gu, as well as handpieces (Figure 2b for PS03, R11, and R09-2 Gu). Figure 3 shows the entire course of the procedure.
case_images: Pathological tissue of Case 1. Pathology is assessed at each stage as follows: M1: at the time of mid-urethral sling (MUS) removal surgery (a. epithelium, b. deep); M-T1: one year after MUS removal (c); L-T1: one year after the third laser treatment (d).. Va: vacuole formed when the mesh fell off during pathological specimen preparation, Ep: mucosa, white arrow: shedding of mucosal epithelium, gray arrow: lack of mucosal epithelium
case_images: cureus-0016-00000051431-i04.jpg
case_images: PMC10758587_01_cureus-0016-00000051431-i04.jpg
case_images: FIG4
case_images: Figure 4 shows the pathology at M1 (Figure 4a, b), M-T1 (Figure 4c), and L-T1 (Figure 4d). In Figure 4a, the area containing the artificial mesh became detached during the preparation of the specimen, resulting in a blank formation (Va). Figure 4b confirms vacuolation (Va) and foreign body granulation (gray arrow). In Figure 4c, although the empty cells have disappeared, there is a partial mucosal defect (red arrow) and slight regeneration of the mucosal epithelium (Ep). In Figure 4d, normal mucosa (Ep) proliferates, and multinucleate giant cells and empty cells are absent.
case_images: Overall course of pain, SUI, and OAB in Case 5. Left vertical axis: degree of pain (VAS), right vertical axis: one-hour pad test, horizontal axis: time, black circles: VAS, gray bars: one-hour pad test, red rectangle: duration of fesoterodine fumarate administration. SUI: stress urinary incontinence, VAS: pain score on a visual analog scale (0: no pain to 10: maximal pain), T0: first visit, M1: first mid-urethral sling (MUS) removal surgery, M-T1: one year after MUS removal surgery, L1: first laser treatment, L2: second laser treatment, L3: third laser treatment, L-T1: one year after the third laser treatment (L3)
case_images: cureus-0016-00000051431-i11.jpg
case_images: PMC10758587_05_cureus-0016-00000051431-i11.jpg
case_images: FIG11
case_images: Figure 11 shows the entire process.
case_images: PMC10758587_02
case_images: Overall course of pain and SUI in Case 2. Left vertical axis: degree of pain (VAS), right vertical axis: one-hour pad test, horizontal axis: time, black circles: VAS, gray bars: one-hour pad test. SUI: stress urinary incontinence, VAS: pain score on a visual analog scale (0: no pain to 10: maximal pain), T0: first visit, M1: first surgery to remove the mid-urethral sling (MUS), M2: second surgery to remove the MUS, M-T1: one year after M2, L1: first laser treatment, L2: second laser treatment, L3: third laser treatment, L-T1: one year after the third laser treatment (L3)
case_images: cureus-0016-00000051431-i05.jpg
case_images: PMC10758587_02_cureus-0016-00000051431-i05.jpg
case_images: FIG5
case_images: Figure 5 shows the entire process of the procedure.
case_images: Pathological tissue of Case 2. Pathology is assessed at each stage as follows: M1: at the time of mid-urethral sling (MUS) removal surgery (a. epithelium, b. deep); M-T1: one year after MUS removal (c); L-T1: one year after the third laser treatment (d).. Va: vacuole formed when the mesh fell off during the pathological specimen preparation, Ep: mucosa, black arrows: foreign-body giant cells, white arrows: most of the epithelium has fallen off, gray arrows: foreign body defective granulation, red arrows: missing mucous membrane, blue arrows: defective granulation
case_images: cureus-0016-00000051431-i06.jpg
case_images: PMC10758587_02_cureus-0016-00000051431-i06.jpg
case_images: FIG6
case_images: Figure 6 shows the histopathology of Case 2. Figure 6a shows a sample containing epithelium at M1. Figure 6b shows a deeper area, with a large foreign body defective granulation at the edge of multiple vacuolations (gray arrows).
case_images: PMC10758587_03
case_images: MUS removal surgery procedure (Case 1). a. Assessment of pain location (white arrows) before applying anesthesia. b. After lumbar or general anesthesia, an incision is made into the painful vaginal mucosa and the vaginal wall is peeled to expose the mesh (gray arrow). c. The extracted mesh.
case_images: cureus-0016-00000051431-i01.jpg
case_images: PMC10758587_05_cureus-0016-00000051431-i01.jpg
case_images: FIG1
case_images: Figures 12a and 12b show M1, in which a large vacuolization (Va) is observed in the area where the mesh was inserted, and a large number of foreign-body giant cells (black arrows) are observed.
case_images: Overall course of pain and SUI in Case 3. Left vertical axis: degree of pain (VAS), right vertical axis: one-hour pad test, horizontal axis: time, black circles: VAS, gray bars: one-hour pad test. SUI: stress urinary incontinence, VAS: pain score on a visual analog scale (0: no pain to 10: maximal pain), T0: first visit, M1: first mid-urethral sling (MUS) removal surgery, M-T1: one year after MUS removal surgery, L1: first laser treatment, L2: second laser treatment, L3: third laser treatment, L-T1: one year after the third laser treatment (L3)
case_images: cureus-0016-00000051431-i07.jpg
case_images: PMC10758587_03_cureus-0016-00000051431-i07.jpg
case_images: FIG7
case_images: Figure 7 shows the entire process.
case_images: Pathological histology of Case 3. Pathology is measured at each stage as follows: M1: at the time of mid-urethral sling (MUS) removal surgery (a. epithelium, b. deep); M-T1: one year after MUS removal (c); L-T1: one year after the third laser treatment (d).. Va: vacuole formed when the mesh fell off during pathological specimen preparation, Ep: mucosa, black arrows: foreign-body giant cells, white arrows: shedding of mucous membrane, gray arrows: foreign body granuloma, red arrows: edema
case_images: cureus-0016-00000051431-i08.jpg
case_images: PMC10758587_03_cureus-0016-00000051431-i08.jpg
case_images: FIG8
case_images: Figure 8 shows the histopathology of Case 3. Figures 8a and 8b show the pathology at M1. At M-T1, the tissue has regenerated, and the mucous membrane is observed, but there is overall edema, which is abnormal (red arrows, Figure 8c). At L-T1, normal mucosa is seen to have proliferated and regenerated (Figure 8d).
case_images: PMC10758587_04
case_images: MUS removal surgery procedure (Case 1). a. Assessment of pain location (white arrows) before applying anesthesia. b. After lumbar or general anesthesia, an incision is made into the painful vaginal mucosa and the vaginal wall is peeled to expose the mesh (gray arrow). c. The extracted mesh.
case_images: cureus-0016-00000051431-i01.jpg
case_images: PMC10758587_05_cureus-0016-00000051431-i01.jpg
case_images: FIG1
case_images: Figures 12a and 12b show M1, in which a large vacuolization (Va) is observed in the area where the mesh was inserted, and a large number of foreign-body giant cells (black arrows) are observed.
case_images: Overall course of pain, SUI, and OAB in Case 4. Left vertical axis: pain level (VAS), right vertical axis: one-hour pad test, horizontal axis: time, black circles: VAS, gray bars: one-hour pad test. SUI: stress urinary incontinence, VAS: pain score on a visual analog scale (0: no pain to 10: maximal pain), T0: first visit, M1: first mid-urethral sling (MUS) removal surgery, M-T1: one year after MUS removal surgery, L1: first laser treatment, L2: second laser treatment, L3: third laser treatment, L-T1: one year after the third laser treatment (L3)
case_images: cureus-0016-00000051431-i09.jpg
case_images: PMC10758587_04_cureus-0016-00000051431-i09.jpg
case_images: FIG9
case_images: Figure 9 shows the entire process of the procedure.
case_images: Pathological tissue of Case 4. Pathology is assessed at each stage as follows: M1: at the time of mid-urethral sling (MUS) removal surgery (a. epithelium, b. deep); M-T1: one year after MUS removal (c), L-T1: one year after the third laser treatment (d). Va: vacuole formed when the mesh fell off during pathological specimen preparation, Ep: mucosa, black arrow: ossification, white arrow: shedding of mucous membrane, gray arrows: foreign body granuloma
case_images: cureus-0016-00000051431-i10.jpg
case_images: PMC10758587_04_cureus-0016-00000051431-i10.jpg
case_images: FIG10
case_images: In the histopathological photographs shown in Figure 10, in M1, the epithelium has become detached, and numerous vacuoles (Va) containing a mesh and foreign-body giant cells (gray arrows) are observed (Figures 10a, b). In M-T1, the epithelium has regenerated, and the foreign-body giant cells have disappeared (Figure 10c). No inflammation within the tissue is observed (Figure 10d).
case_images: PMC10758587_05
case_images: MUS removal surgery procedure (Case 1). a. Assessment of pain location (white arrows) before applying anesthesia. b. After lumbar or general anesthesia, an incision is made into the painful vaginal mucosa and the vaginal wall is peeled to expose the mesh (gray arrow). c. The extracted mesh.
case_images: cureus-0016-00000051431-i01.jpg
case_images: PMC10758587_05_cureus-0016-00000051431-i01.jpg
case_images: FIG1
case_images: Figures 12a and 12b show M1, in which a large vacuolization (Va) is observed in the area where the mesh was inserted, and a large number of foreign-body giant cells (black arrows) are observed.
case_images: Overall course of pain, SUI, and OAB in Case 5. Left vertical axis: degree of pain (VAS), right vertical axis: one-hour pad test, horizontal axis: time, black circles: VAS, gray bars: one-hour pad test, red rectangle: duration of fesoterodine fumarate administration. SUI: stress urinary incontinence, VAS: pain score on a visual analog scale (0: no pain to 10: maximal pain), T0: first visit, M1: first mid-urethral sling (MUS) removal surgery, M-T1: one year after MUS removal surgery, L1: first laser treatment, L2: second laser treatment, L3: third laser treatment, L-T1: one year after the third laser treatment (L3)
case_images: cureus-0016-00000051431-i11.jpg
case_images: PMC10758587_05_cureus-0016-00000051431-i11.jpg
case_images: FIG11
case_images: Figure 11 shows the entire process.
case_images: Histopathological tissue in Case 5. Pathology is assessed at each stage as follows: M1: at the time of mid-urethral sling (MUS) removal surgery (a. epithelium, b. deep); M-T1: one year after MUS removal (c); L-T1: one year after the third laser treatment (d). Va: vacuole formed when the mesh fell off during pathological specimen preparation, Ep: mucosa, black arrows: foreign-body giant cells, white arrow: shedding of mucous membrane, green arrow: fibrin (scarring), yellow arrow: cyst formation
case_images: cureus-0016-00000051431-i12.jpg
case_images: PMC10758587_05_cureus-0016-00000051431-i12.jpg
case_images: FIG12
case_images: Figure 12 shows the pathology of Case 5. Figures 12a and 12b show M1, in which a large vacuolization (Va) is observed in the area where the mesh was inserted, and a large number of foreign-body giant cells (black arrows) are observed. Figure 12c, the vacuoles have disappeared, but macroscopically, scars are observed to exist uniformly (green arrows).