You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Female Urology II1 Apr 20101676 PRESENTATION AND MANAGEMENT OF IATROGENIC FOREIGN BODIES OF THE LOWER URINARY TRACT FOLLOWING PELVIC SURGER Priya Padmanabhan, Ryan Hutchinson, W. Stuart Reynolds, Shady Salem, Harriette Scarpero, and Roger Dmochowski Priya PadmanabhanPriya Padmanabhan More articles by this author , Ryan HutchinsonRyan Hutchinson More articles by this author , W. Stuart ReynoldsW. Stuart Reynolds More articles by this author , Shady SalemShady Salem More articles by this author , Harriette ScarperoHarriette Scarpero More articles by this author , and Roger DmochowskiRoger Dmochowski More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1500AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The surgical use of mesh technologies for pelvic surgery may increase the risk of mesh complications. These complications present challenges for identification and treatment. We review presentation, management and outcomes for a series of iatrogenic foreign bodies of the female lower urinary tract. METHODS Retrospective review of 85 patients with mesh complications following pelvic surgery between 11/2000 and 9/2009 were evaluated for demographics, presenting symptoms, prior procedures, type of foreign body, technique and outcomes. RESULTS Mean patient age was 55.1 years (22.2 - 89.8). 85 patients (48 extrusions, 40 erosions, 3 both) were treated. 42 (49.4%) had prior pelvic surgery prior to source procedure. Table 1 contains presentation, management and outcomes. Symptoms improved with excision in all extrusions, except 1 (0.45%) re-excision for persistent vaginal pain, 2 delayed re-excisions and 1 (0.9%) with persistent obturator pain requiring orthopedic exposure and mesh removal. 3 (6.3%) extrusion patients developed de novo urgency, while 5 (10.4%) had resolution of mixed urinary incontinence (MUI). Location of the foreign body erosion was urethra in 12 (30%), and bladder in 31 (77.5%). All except 2 erosions, were evident cystoscopically. 3 patients (7.5%) had a secondary procedure (2 partial cystectomy, 1 abdominal fistula repair), with 1 (2.5%) requiring a third procedure (complex urethroplasty). 2 patients (5%) developed de novo urgency, while 7 (17.5%) had resolution of MUI. 3 (2 pubovaginal sling, 1 bulking agent) patients with stress urinary incontinence (SUI) underwent anti-incontinence therapy. Table 1. Presentation, Management and Outcomes of Extrusions and Erosions EXTRUSIONS EROSIONS Common presenting Symptoms dyspareunia (45.8%), pain (33%), incontinence (29.2%) incontinence (55%), pain (42.5%), frequency/ urgency (40%) Time to Presentation 6.1 months (0 – 84) 10.6 months (0 – 122.6) Source Procedure 39 anti-incontinence (81.3%) 18 prolapse (37.5%) 34 anti-incontinence (85%) 9 prolapse (22.5%) Type of Mesh 44 polypropylene (91.7%) 2 porcine dermis (4.2%) 1 protegen sling (2%) 24 polypropylene (60%) 24 suture (60%) 4 protegen sling (10%) 2 xenograft (5%) 2 goretex (5%) Prior Outside Attempt at Removal 10.8% 9 transvaginal, 1endoscopic 37.5% 7 transvaginal, 6 endoscopic, 2 laparoscopic Initial Management 100% mesh excision and simple vaginal closure 17 (42.5%) cystorrhaphy or partial cystectomy 13 (32.5%) urethroplasty (6 interposition grafts) 4 (10%) endoscopic 2 (5%) abdominal fistula repair + interposition graft 1 ileal conduit Final Subjective Outcomes 36 (75%) cured 10 (20.8%) improved 21 (52.5%) cured 14 (35%) improved New SUI rate 3 (6.25%) 1 (2.5%) CONCLUSIONS This is the largest series to date of iatrogenic foreign body erosions of the bladder and urethra. While this complex population had multiple prior repairs, the low reoperation rate and dramatic symptom regression supports our management of non-endoscopic vesical repair and interpositional grafting for complex urethrovaginal fistulas. Nashville, TN© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e647-e648 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Priya Padmanabhan More articles by this author Ryan Hutchinson More articles by this author W. Stuart Reynolds More articles by this author Shady Salem More articles by this author Harriette Scarpero More articles by this author Roger Dmochowski More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...