2086 COMPLEX RECTOVAGINAL FISTULA AFTER POSTERIOR COMPARTMENT REPAIR WITH SYNTHETIC MESH: IDENTIFICATION AND MANAGEMENT OF THIS DEVASTATING COMPLICATION

Abstract

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Pelvic Prolapse1 Apr 20112086 COMPLEX RECTOVAGINAL FISTULA AFTER POSTERIOR COMPARTMENT REPAIR WITH SYNTHETIC MESH: IDENTIFICATION AND MANAGEMENT OF THIS DEVASTATING COMPLICATION Vian Nguyen, Sophie Fletcher, and Michael Snyder Vian NguyenVian Nguyen Houston, TX More articles by this author , Sophie FletcherSophie Fletcher Houston, TX More articles by this author , and Michael SnyderMichael Snyder Houston, TX More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2381AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The use of synthetic mesh for transvaginal pelvic organ prolapse (POP) repair is associated with the rare complication of mesh erosion into hollow viscera. This study presents a single-institution series of complex rectovaginal fistulas (RVF) after synthetic mesh-augmented POP repair. METHODS IRB approval was obtained for this retrospective study. Data was collected on all consecutive patients undergoing RVF repair after POP surgery from 2006–2009. Patient demographics, clinical history, physical exam, diagnostic testing, fistula repair techniques and follow up data were recorded. RESULTS Twenty-two patients underwent RVF repair at our multidisciplinary center for pelvic medicine from 2006 – 2009. Etiologies of RVF were: malignancy (n=12), uterosacral ligament suspension (n=1), robotic sacrocolpopexy (n=1), lap sacrocolpopexy (n=1), and transvaginal POP repair with mesh (n=7). Of the 9 patients with RVF after POP repair using mesh, median age was 52 yrs (range 33–66). Time to presentation was 9 to 960 days after prolapse repair. Presenting symptoms included: drainage of stool in the vagina (4), rectal bleeding (2), dyspareunia (2), vaginal bleeding (1), rectal pain (1), dyschezia (1), mesh protruding from anus (1), and sepsis (1). Mesh was palpated in the rectum in 5 patients. Patients required a median 3 (range 1–5) procedures for definitive RVF repair. Diverting ileostomy was necessary in 5 of 9 patients; one patient refused. Repairs included advancement flap (3), transperineal repair with levator flaps (2), closure with gracilis flap, (1), low anterior resection with primary anastamosis (1), and mesh removal with primary closure (2). Median follow up was 13 mo. (range 6–46). Two patients have persistent fistulas on follow up; one is still diverted. Of those with successful repairs, persistent pain (3) and vaginal mesh extrusion (1) still complicate RVF repair. CONCLUSIONS This series highlights the significant impact of synthetic mesh complications in the posterior compartment. Rectal complications can occur after any posterior POP repair, but those involving mesh are especially disastrous. These complications should be cautionary for synthetic graft use by those with limited experience or with alternate choice of traditional repair. When symptoms of RVF present, a colon and rectal specialist should be involved as soon as possible to minimize repeated attempts at repair and prolonged morbidity. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e834 Peer Review Report Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Vian Nguyen Houston, TX More articles by this author Sophie Fletcher Houston, TX More articles by this author Michael Snyder Houston, TX More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...