Abstract

Patients with multiple failed vaginal surgeries utilizing synthetic mesh present a therapeutic challenge. We present a case of a 75-year-old woman with severe stress urinary incontinence and mesh extrusion after two failed synthetic sling surgeries. Surgical reconstruction consisted of mesh excision, urethral reconstruction with vaginal tubularization, autologous rectus fascia sling placement. The patient developed a vaginal hematoma and wound dehiscence post-operatively, which was treated with surgical debridement and hyperbaric oxygen (HBO). The patient’s wound healed well, and she regained full continence, which was sustained at 10 months postoperatively. HBO therapy promotes wound healing after complex transvaginal reconstructive surgery.

Highlights

  • Vaginal mesh placement for stress urinary incontinence (SUI) or pelvic organ prolapse (POP) is a common procedure

  • A surgical field with disrupted vascular supply and suboptimal tissue quality after prior operations presents a challenge to surgical reconstruction

  • A 4.1% rate of symptomatic retropubic hematoma after suburethral sling has been previously reported [1], and this is presumed to be higher in patients requiring anticoagulation

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Summary

Introduction

Vaginal mesh placement for stress urinary incontinence (SUI) or pelvic organ prolapse (POP) is a common procedure. A 75-year-old gravida 10, para 9, post-menopausal woman presented for treatment of persistent SUI after a previous abdominal hysterectomy and two failed synthetic sling procedures. Her symptoms consisted of severe SUI, enuresis, and urinary urgency. By post-operative day 25, the patient had developed worsening vaginal bleeding with a hematoma under the vaginal flap, necrotic wound edges, and a 3 cm dehiscence of the neourethra without signs of infection. The patient’s hemoglobin remained stable and therapeutic anticoagulation was continued She developed additional devitalized tissue at the anterior vaginal wall. No objective SUI was demonstrated during physical exam At her tenth month follow-up, the patient continued to have complete continence

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