1873 MESH EROSIONS INTO THE LOWER URINARY TRACT: CORRELATION TO INTRA-OPERATIVE CYSTOSCOPY

Abstract

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Female Urology1 Apr 20111873 MESH EROSIONS INTO THE LOWER URINARY TRACT: CORRELATION TO INTRA-OPERATIVE CYSTOSCOPY Laura Chang Kit, Melissa Kaufman, W.S. Reynolds, and Roger Dmochowski Laura Chang KitLaura Chang Kit Nashville, TN More articles by this author , Melissa KaufmanMelissa Kaufman Nashville, TN More articles by this author , W.S. ReynoldsW.S. Reynolds Nashville, TN More articles by this author , and Roger DmochowskiRoger Dmochowski Nashville, TN More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1955AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Tertiary care centers have witnessed an increase in referrals for mesh erosion into the lower urinary tract. We evaluated key aspects of the source procedures to identify factors contributing to graft erosion. METHODS Medical records of female patients referred for mesh erosion into the lower urinary tract from January 2000 to August 2010 were reviewed. Patients were excluded if their source procedure operative report was not available. We recorded age, hospital type, implanting surgeon, anaesthetic, source procedure, graft material, concomitant surgeries, intra-operative cystoscopy, complications, and erosion location. RESULTS 36 patients were referred for mesh erosion over the ten year period. Source procedure records were available for 18 patients (50%). All procedures were conducted at community hospitals. 11 operations (61%) were performed by gynaecologists and 7 (39%) by urologists. 17 patients (94%) had a polypropylene mid-urethral sling. 7 patients (39%) had a concomitant vaginal procedure (3 hysterectomies, 4 prolapse repairs). Intra-operative cystoscopy was performed by 78% (14) of surgeons (4/11 gynecologists (36%) did not perform). 5 patients (28%) had recognized intra-operative complications which were repaired by their operating gynaecologists. 60% of these injuries were detected on intra-operative cystoscopy. 6 patients (33%) had an immediate post-operative complication. Erosions occurred at the urethra (39%) and bladder walls (39%) more frequently than at the bladder neck (11%) and trigone (11%). CONCLUSIONS Patients with mesh erosion into the urinary tract often have a protracted course of management prior to referral. Details of source procedures are difficult to obtain, and are frequently poorly documented, thus only 50% of patients were included. Almost 30% of patients had a documented intra- or peri-operative complication at the time of their source procedure. Most patients underwent intra-operative cystoscopy, allowing early recognition of bladder injuries in 60% of cases. However, in 79% of patients undergoing cystoscopy, no mesh was visualized, despite most erosions occurring at conspicuous areas. This may imply that mesh erosions can develop over time, rather than result directly from misplacement of graft into the urinary tract. This data additionally reveals the exceptional risk of proceeding with mesh placement following known intra-operative urinary tract injury. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e751 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Laura Chang Kit Nashville, TN More articles by this author Melissa Kaufman Nashville, TN More articles by this author W.S. Reynolds Nashville, TN More articles by this author Roger Dmochowski Nashville, TN More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...