# Novel Management of Post-laparoscopic Sacrocolpopexy-Associated Overactive Bladder: A Combined Approach of Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) Mesh Removal and Fotona Laser Therapy

## TL;DR

A new treatment combining mesh removal and laser therapy successfully resolved overactive bladder symptoms in a patient after a pelvic floor surgery.

## Contribution

A novel combined approach using vNOTES mesh removal and Fotona laser therapy for post-LSC OAB syndrome is introduced.

## Key findings

- The patient's OAB symptoms were completely resolved after combined vNOTES and Fotona laser therapy.
- The Overactive Bladder Symptom Score significantly improved following treatment.
- Sustained improvements in bladder function and quality of life were observed post-treatment.

## Abstract

This case report presents a novel approach for managing overactive bladder (OAB) syndrome following laparoscopic sacrocolpopexy (LSC) using vaginal natural orifice transluminal endoscopic surgery (vNOTES) and Fotona laser therapy. A 73-year-old woman with severe OAB syndrome and pelvic pain after LSC underwent mesh removal via vNOTES. Despite the initial improvement in OAB symptoms, the patient continued to experience persistent urinary issues. Subsequent treatment with Fotona's non-ablative erbium:yttrium-aluminum-garnet (Er:YAG) laser therapy, including Vaginal Erbium Laser (VEL) and Urethral Erbium Laser (UEL), led to the complete resolution of OAB symptoms. The patient's Overactive Bladder Symptom Score (OABSS) significantly improved following combined vNOTES and laser therapy. Follow-up assessments revealed sustained improvements in bladder function and quality of life. This case highlights the potential of combining vNOTES for mesh removal and Fotona laser therapy for managing post-LSC complications, particularly in cases in which mesh-related issues contribute to persistent OAB syndrome. The successful outcome, as evidenced by symptom resolution and improved OABSS, suggests that this approach may offer a viable solution for patients experiencing persistent OAB syndrome following LSC, especially when conventional treatment fails. This report contributes to the limited body of evidence on managing LSC-related OAB syndrome and introduces a promising treatment protocol using Fotona laser therapy, which merits further investigation in larger studies focused on OAB management after pelvic floor surgery.