Vaginal Mesh Exposure Research Articles

A review on the role of laparoscopic sacrocervicopexy.

To provide an update on the outcomes and complications of laparoscopic (or robot-assisted) sacrocervicopexy with and without supracervical hysterectomy, and highlight the differences with sacrocolpopexy technique based on the most recent evidence. Laparoscopic and robot-assisted sacrocervicopexy with supracervical hysterectomy and sacrohysteropexy have good success rates, with a mean objective success rate of 96% (range 90-100%), subjective success rates of 80-95% and mean reoperation rate of 3%. Also, pelvic symptoms and quality of life improved after laparoscopic sacrocervicopexy. These results are similar to laparoscopic and abdominal sacrocolpopexy, and are confirmed by the results of two comparative studies. Mesh erosion risk is very low in patients treated with laparoscopic sacrocervicopexy. Studies that compare laparoscopic sacrocolpopexy with concomitant total hysterectomy and sacrocervicopexy with subtotal hysterectomy show that total hysterectomy is associated with a greater prevalence of vaginal mesh exposure when compared with a subtotal hysterectomy. In case of sacralpexy, if it is decided to proceed with a hysterectomy, it is recommended to limit this to a subtotal. The benefits of laparoscopic sacrocervicopexy with or without supracervical hysterectomy in terms of outcomes and reduced risk of mesh erosion in comparison with sacrocolpopexy and concomitant total hysterectomy have to be confirmed by randomized controlled trials. Moreover, standardization of surgical technique is mandatory.

Single-incision sling operations for urinary incontinence in women.

Single-incision sling operations for urinary incontinence in women.

Traitement du prolapsus génital par renfort prothétique léger par voie vaginale

To evaluate the results associated with the transvaginal repair of genital prolapse using a tension free light-weight polypropylene mesh. One hundred and fifteen patients have been treated in a single centre. Pre-operative and operative data and complications were recorded. Patients were examined at 1, 6 and 12 months. Anatomical failure was defined as follows: Pelvic Organ Prolapse Quantification (POP-Q) stage II or more. Seventy-seven (67%) patients completed 6 months follow-up and 45 (39%) patients completed 12 months follow-up. Finally, 70 (61%) patients were lost to follow-up, including 2 deaths (not related to surgery). Mean age was 66 years. All patients were treated with an anterior and apical and 20 patients were additionally treated with a posterior mesh. Among the 77 patients who completed 6 months follow-up, the complications reported were: 2 (2%) bladder injuries, 1 (1%) hematoma, 1 (1%) bleeding>200 mL and 1 (1%) vaginal mesh exposure. At one year, 6 (7%) patients suffered from urinary stress incontinence, 5 (4%) suffered from urgency and 4 (5%) had dyspareunia. Among the 45 patients who completed 12 months follow-up, functional success was 95% and anatomical success was 77%. In this series, the placement of a light-weight transvaginal polypropylene mesh was associated with good functional results and a moderate prevalence of complications. 4.

PD33-12 ANALYSIS OF LUTS AND DYSPAREUNIA IN PATIENTS UNDERGOING TRANSVAGINAL MESH REMOVAL FOR MESH EXPOSURE AND EROSION

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Female Urology I1 Apr 2014PD33-12 ANALYSIS OF LUTS AND DYSPAREUNIA IN PATIENTS UNDERGOING TRANSVAGINAL MESH REMOVAL FOR MESH EXPOSURE AND EROSION Lara MacLachlan, Justin Ellett, Kelly Johnson, Gini Ikwuezunma, Michelle Koski, Ross Rames, Ahmed El-Zawahry, and Eric Rovner Lara MacLachlanLara MacLachlan More articles by this author , Justin EllettJustin Ellett More articles by this author , Kelly JohnsonKelly Johnson More articles by this author , Gini IkwuezunmaGini Ikwuezunma More articles by this author , Michelle KoskiMichelle Koski More articles by this author , Ross RamesRoss Rames More articles by this author , Ahmed El-ZawahryAhmed El-Zawahry More articles by this author , and Eric RovnerEric Rovner More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2295AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Transvaginal mesh has been commonly used in the operative management of stress urinary incontinence (SUI) and pelvic organ prolapse. Vaginal mesh exposure and mesh erosion into the urinary tract is a complication seen with these surgeries. We reviewed our experience with lower urinary tract symptoms (LUTS) and dyspareunia outcomes following mesh explantation over a 7-year period in those patients who underwent surgery for mesh removal. METHODS A retrospective review of patients who underwent explantation of vaginal mesh from 2007 to 2013 was conducted. A total of 191 patients were identified of which 77 patients had evidence of vaginal mesh exposure and/or mesh erosion into the urinary tract. Other indications for mesh explantation included bladder outlet obstruction, pain, and dyspareunia. The following symptoms were evaluated at baseline and at 3 months follow-up: storage symptoms (frequency, urgency and nocturia=SS), voiding symptoms (hesitancy, straining, incomplete emptying and positional voiding=VS), dyspareunia, urge urinary incontinence (UUI), and SUI. RESULTS The most common presenting symptoms for the entire cohort were SS (76.6%) and VS (76.5%). Of the cohort, 53 patients had vaginal mesh exposure, 24 had erosion with 5 having both exposure and erosion. Patients presenting with vaginal mesh exposure did not differ in the array of presenting symptoms as compared with those patients with mesh erosion. The group of patients who had neither mesh exposure nor erosion had a significant improvement of all their symptoms at 3 months (p<0.03). Of the patients with vaginal mesh exposure, there was a statistical improvement in all of their symptoms, with the exception of SUI. The patients with mesh erosion had a significant improvement in VS (p<0.001) and dyspareunia (p=0.008), but no improvement in SS, UUI, or SUI. CONCLUSIONS This study demonstrates improvement in symptoms for those patients undergoing mesh removal surgery who do not have mesh exposure or erosion. However, for those patients with mesh erosion into the urinary tract there is comparatively less success in improving their urinary symptoms. This knowledge can be used in counseling patients with LUTS related to mesh complications prior to surgical mesh removal. No Mesh Exposure or Erosion (n=113) Mesh Exposure (n=53) Mesh Erosion (n=24) Presenting Symptoms: Storage 97 (85.8%) 40 (75.5%) 19 (79.2%) Voiding 78 (69.0%) 21 (39.6%) 11 (45.8%) Dyspareunia 41 (36.3%) 36 (67.9%) 14 (58.3%) UUI 66 (58.4%) 31 (58.5%) 14 (58.3%) SUI 49 (43.4%) 28 (52.8%) 12 (50.0%) 3 Months F/U: Storage 67 (59.3%) 24 (45.3%) 14 (58.3%) Voiding 29 (25.7%) 5 (9.4%) 5 (20.8%) Dyspareunia 12 (10.6%) 8 (15.1%) 6 (25.0%) UUI 45 (39.8%) 17 (32.1%) 15 (62.5%) SUI 49 (43.4%) 28 (52.8%) 12 (50.0%) © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e845 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Lara MacLachlan More articles by this author Justin Ellett More articles by this author Kelly Johnson More articles by this author Gini Ikwuezunma More articles by this author Michelle Koski More articles by this author Ross Rames More articles by this author Ahmed El-Zawahry More articles by this author Eric Rovner More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

V1-05 APICAL SLING FOR FOR SITE SPECIFIC PELVIC ORGAN PROLAPSE REPAIR

You have accessJournal of UrologyFemale Pelvic Medicine & Reconstructive Surgery1 Apr 2014V1-05 APICAL SLING FOR FOR SITE SPECIFIC PELVIC ORGAN PROLAPSE REPAIR Paulo Palma, Cassio Riccetto, Tiago Aguiar, and Wilmar Azal Neto Paulo PalmaPaulo Palma More articles by this author , Cassio RiccettoCassio Riccetto More articles by this author , Tiago AguiarTiago Aguiar More articles by this author , and Wilmar Azal NetoWilmar Azal Neto More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.599AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Sacral colpopexy has become a widely used procedure for apical vaginal prolapse repair, but the risk of bleeding, injury of the rectum, as well as other abdominal viscera still represents a major concern. Posterior transcoccigeal mesh brings the risks of the transgluteal route, mostly pudendal neurovascular bundle injury. A new procedure for colpopexy was developed in order to allow for a single incision apical transvaginal level I repair, using a small amount of synthetic material. The kit contains a macro porous polypropylene 8 x 1,2 cm tape and two polypropylene self anchoring system attached to polypropylene threads and a disposable retractable insertion guide for placement of the anchoring system into the sacrospinous ligaments. This video highlights the technical details of the procedure. METHODS It is presented the surgical treatment of a patient with a vaginal apical (uterine) prolapse stage 3 according to the POP-Q system. A vertical incision is done in the anterior vaginal. Blunt dissection is performed towards the ischial spine, and coccigeous muscle and sacrospinous ligaments are identified bilaterally. Then, the retractable insertion guide is primed with the multipoint anchoring system and introduced toward the ischial spine guided by surgeon’s index finger and implanted into the sacrospinous ligament, 1.5 cm medial to ischial spine. The tissue anchoring system is delivered and the retractable insertion guide is gently retracted. Next reconstruction of the pericervical ring is performed then, both sides of the sling are attached to the polypropylene threads and knots are tied in order to elevate the cervix and the vaginal apex to DeLancey’s level one. Finally, the vaginal incision is closed in the usual manner. RESULTS This procedure was performed in 10 patients (mean age 65 years-old) with POP-Q stage 3 apical prolapse. No intra-operative complications or postoperative significant adverse events were observed. None presented post-operative vaginal mesh exposure. Mean follow up was 12 months (6 to 18 months). In this short term follow up, all of the patients were considered cured (POP-Q apical stage was 0 or 1). CONCLUSIONS Apical sling kit adds the advantages of single incision transvaginal approach, safety and level I correction of apical defect, without the mesh related complications. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e292-e293 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Paulo Palma More articles by this author Cassio Riccetto More articles by this author Tiago Aguiar More articles by this author Wilmar Azal Neto More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Concomitant trocar-guided transvaginal mesh surgery with a midurethral sling in treating advanced pelvic organ prolapse associated with stress or occult stress urinary incontinence

ObjectiveThe purpose of this study was to evaluate the efficacy and feasibility of concomitant trocar-guided transvaginal mesh (TVM) surgery with a midurethral sling (MUS) for treating women with advanced pelvic organ prolapse (POP) and stress urinary incontinence (SUI) or occult SUI (OSUI). Materials and methodsEighty-nine women with advanced POP and SUI or OSUI were retrospectively enrolled. The Total Prolift and Tension-free Vaginal Tape-Obturator Systems were used for trocar-guided TVM surgery and MUS. Patients received regular follow-up at 1 week, and 1 month, 3 months, 6 months, and 12 months postoperatively, and then annually thereafter. The endpoints were the success rate for POP, and perioperative and postoperative complications. Functional outcomes were the presence of voiding difficulty, persistent or de novo overactive bladder symptoms, postoperative SUI, and paresthesia. ResultsThe median follow-up period was 35 months (range, 12–50 months). Within the follow-up period, 84 patients (94.4%) were objectively cured, five patients (5.6%) had vaginal apical mesh exposure, 29 individuals (32.6%) had persistent or de novo overactive bladder symptoms, six individuals (22.5%) had de novo SUI (two were found by urodynamics), and nine individuals (10.1%) had voiding difficulties (two were found by urodynamics). In addition, the vaginal hysterectomy group had greater blood loss, longer operation times, and a higher mesh erosion rate compared to the uterine suspension group. ConclusionConcomitant trocar-guided TVM surgery and MUS with the use of total Prolift and Tension-free Vaginal Tape-Obturator offer good efficacy in treating women with advanced POP and SUI or OSUI. The vaginal hysterectomy group had more perioperative complications.

Anterior colporrhaphy compared with collagen‐coated transvaginal mesh for anterior vaginal wall prolapse: a randomised controlled trial

To investigate the anatomical cure rate and complications related to collagen-coated mesh for cystocele, compared with a conventional anterior colporrhaphy. A randomised controlled study. Six departments of obstetrics and gynaecology in Norway, Sweden, Finland, and Denmark. Women aged 55 years or older, referred for surgery with a prolapse of the anterior vaginal wall of stage 2 or higher. Women scheduled for primary cystocoele surgery were randomised to either anterior colporrhaphy or a collagen-coated Prolene mesh. Power analysis indicated that 130 patients had to be randomised. All patients were evaluated using the Pelvic Organ Prolapse-Quantification (POP-Q) measurement. Quality of life, symptoms, and sexual function were evaluated using the Pelvic Floor Impact Questionnaire, the Pelvic Floor Distress Inventory, and the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire. The primary outcome was objective cure, defined as prolapse below POP-Q stage 2 at the 12-months follow-up. Secondary outcomes were quality of life, symptoms, and presence (or not) of complications. In total, 161 women were randomised to either anterior colporrhaphy or mesh (participant ages 64.9 ± 6.4 years versus 64.7 ± 6.6 years, respectively; mean ± SD). The objective cure rate was 39.8% (95% CI 28.6-50.9%) in the anterior colporrhaphy group, compared with 88.1% (95% CI 80.7-95.6%) in the mesh group (P < 0.001). Vaginal mesh exposure occurred in ten women (13.3%) and dyspareunia occurred in two women (2.7%, not significant) in the mesh group at the 12-months follow-up. Questionnaires revealed no difference between the groups. Our study demonstrates a significantly improved objective cure rate associated with a high exposure rate among women with mesh surgery as opposed to conventional surgery.

High risk of complications with a single incision pelvic floor repair kit: results of a retrospective case series

The aim of this study was to retrospectively assess the extent and severity of the post-operative complications associated with the Pinnacle Pelvic Floor Repair Kit. This is a descriptive analysis of 23 consecutive women who had a prolapse repair with either an anterior (n = 19) or posterior (n = 4) Pinnacle kit. The clinical records of all these patients were available for analysis. Pre-operative data and intra-operative complications were noted. All post-operative complications and repeat surgical interventions were recorded. In addition to pelvic floor symptoms, we looked specifically for pelvic pain and mesh contraction, exposure, extrusion or erosion. Complications were classified according to the joint IUGA/ICS system. Seventy percent (n = 16) of our cohort experienced at least one complication. All, except one, were following an anterior Pinnacle. 10 patients (43 %) had a tender vaginal mesh prominence, including a contraction band anteriorly or at the vaginal apex. Six (26 %) complained of associated buttock, groin or vaginal pain, while the tenderness was only detected during vaginal examination in 4 (16 %) patients. Three (13 %) patients required vaginal mesh excision for severe pain and one required a second procedure. Three patients (13 %) had vaginal mesh exposure and 8 (35 %) developed de novo stress incontinence. Two patients (8 %) developed symptomatic recurrent prolapse, one following mesh excision owing to large mesh exposure. Another patient had an anterior compartment prolapse above and below a tender contracted anterior vaginal mesh. The Pinnacle kit was associated with a high incidence of post-operative complications in this small series.

Exploring Predictors of Mesh Exposure After Vaginal Prolapse Repair

To evaluate clinical, demographic, and surgical factors that may be associated with mesh exposure after vaginal repair of pelvic organ prolapse (POP). Records of women who underwent POP repair with Elevate or Prolift were retrospectively reviewed. Body mass index (BMI), prolapse grade, smoking history, diabetes, steroid and estrogen use, parity, compartment repaired, concurrent hysterectomy, operative time, postoperative pain, change in hemoglobin (ΔHgb) and other characteristics were evaluated for associations with mesh exposure.Categorical variables were examined using Pearson χ test where appropriate, or the Fisher exact test was used. The continuous variables were examined using Wilcoxon rank tests. A multivariable logistic regression analysis was completed to examine predictors of mesh exposure. All analyses used SAS for Windows version 9.2 (Cary, NC). Three hundred thirty-five women underwent repair from 2006 to 2011. Vaginal mesh exposure was identified in 27 (8.1%) of the 335 women. Patients with exposure had longer median follow-up than the group with no exposure (357 vs 145 days; P = 0.0003). The median time to exposure was 96 days (15-1129 days). Mesh exposure was associated with lower BMI (25.2 ± 2.5 vs 27.4 ± 5.1; P = 0.020) and greater ΔHgb (-3.7 ± 1.7 mg/dL vs -2.5 ±1.3; P = 0.0011). Change in hemoglobin decreased over time (P = 0.0005). Exposure rates also decreased over time (17% in 2005 to 12% in 2006, then 5%-8% in 2006-2011) but were not statistically significant (P = 0.49). In this study, vaginal mesh exposure was only associated with ΔHgb and lower BMI.

Tolérance et résultats à 12 mois d’une prothèse légère pour la cure de cystocèle de stade 3-4 par voie vaginale

To assess safety and efficacy at short-term of a light-weight polypropylene mesh (28 g/m2) for stage 3-4 cystocele repair by the vaginal route. A multicentric prospective cohort study, performed between 2010 and 2011 in seven centers. Pre-operative assessment included prolapse quantification using the POP-Q. Pre- and postoperative validated symptoms and quality of life questionnaires were used. Main objective was mesh safety. Secondary objectives were anatomical and functional success. One hundred and eleven patients, with a mean age of 67±9 years, were included in the study, and 94 were included in the analysis (84.7%). In 14 cases (12.8%), it was a secondary surgery. Two intra-operative complications occurred (2.2%). Safety analysis on 86 patients followed up at 12 months (91.5%) has shown satisfaction rate of 98.8% (85/86), mesh contraction rate of 9.3% (8/86), one case of vaginal mesh exposure (1.2%), no cases of pelvic pain and rate of postoperative dyspareunia of 5.5% (3/55). Anatomic success rate on cystocele (Ba point < -1) at short-term was 82/86 (95.3%) and improvement of symptoms and quality of life was highly significant. Five patients (5.3%) were reoperated. Cystocele repair by the vaginal route using a light-weight transobturator polypropylene mesh was safe and efficient at short-term. Long-term data are needed.

Genital prolapse repair with Avaulta Plus® mesh: Functional results and quality of life

Evaluate anatomic and functional outcomes of genital prolapse repair by vaginal route using a mixed polypropylene and porcine skin mesh. Prospective pilot study from January 2009 to January 2011 in the gynecologic department of a tertiary university hospital. Twenty patients with stage II-III genital prolapse underwent anterior wall prolapse repair with anterior Avaulta Plus mesh. Functional results were evaluated using the pelvic floor distress inventory-short form (PFDI-20), the pelvic floor impact questionnaire-7 (PFIQ-7) and the Pelvic Organ Prolapse/Urinary Incontinence Sexual questionnaires (PISQ-12). No per-operative complications occurred. One postoperative hematoma (5%) occurred requiring a second surgery. At a mean follow-up of 19.7 months, three patients had vaginal mesh exposure (15%) requiring a second surgery for two of them. Of the 20 women, 17 (85%) had optimal anatomic results and three (15%) had residual genital prolapse (Ba=-2 in two cases and Bp = -2 in the one). No recurrence was observed during the study period. A significant improvement in the PFDI-20 (P<0.001) and PFIQ-7 scores (P<0.001) was observed but no improvement in the PISQ-12 score. In this series, we reported that genital prolapse repair using Avaulta Plus mesh resulted in a high success rate and improved quality of life but with an important prevalence of vaginal mesh exposure.

Continence outcomes following partial excision of vaginal mesh exposure after mid-urethral tape insertion

To assess the incidence of recurrent stress urinary incontinence (SUI) following vaginal excision of exposed mid-urethral tape (MUT). This was a retrospective observational study in a tertiary urogynaecology unit of an inner city teaching hospital. The population consisted of 41 consecutive women seen with a vaginal mesh exposure following MUT insertion between 2000 and 2009, which failed to resolve with conservative measures. The primary outcome measure was the presence of symptoms of stress urinary incontinence following surgical excision of exposed mesh. The incidence of recurrent SUI following tape excision was 34.1%. Type of mid-urethral tape, menopausal status, and the time interval between tape insertion and excision were not found to be significantly associated with the risk of recurrent SUI. Over a third of women experience recurrent SUI after surgical management of vaginal mesh exposure following MUT insertion. Risk factors may be more comprehensively studied using prospectively collected cohorts.

Modified Distal Urethral Polypropylene Sling (Canal Transobturator Tape) Procedure: Efficacy for Persistent Stress Urinary Incontinence After a Conventional Midurethral Sling Procedure

PurposeDespite reports of persistent stress urinary incontinence (SUI) in patients after the midurethral sling (MUS) procedure, there is no widely accepted definition or cause of the condition. In many cases, the mesh implanted in the previous MUS procedure has been found to have migrated proximally. The aim of this study was to evaluate the efficacy of the modified distal urethral polypropylene sling, or canal transobturator tape (TOT), procedure for persistent SUI after a conventional MUS procedure on the assumption that persistent SUI after MUS is due to the location of the sling.MethodsFrom January 2008 to April 2012, 31 female patients who underwent the canal TOT procedure presented with incontinence or lower urinary tract symptoms (LUTS) were included in this study. We identified patients who had been operated on by use of the conventional MUS procedure at other medical facilities, whose Valsalva leak pressure point was less than 120 cm-H2O by urodynamic study, and who were also diagnosed with persistent SUI. If vaginal or urethral mesh exposure was concomitant with persistent SUI, the mesh was removed completely or in part. Surgical procedures for canal TOT were identical to the original TOT procedures, except in the number and location of the vaginal incisions. Incontinence Impact Questionnaire-Short Form (IIQ-7) and Urogenital Distress Inventory-Short Form (UDI-6) scores were assessed preoperatively and at 3 months postoperatively.ResultsThere were no intraoperative or postoperative complications. Twenty-eight patients (90.3%) showed improvement in incontinence or other LUTS. Postoperative scores of the IIQ-7 (0.65±0.48) and UDI-6 (3.48±2.28) were significantly improved compared with preoperative scores (1.26±0.58 and 7.52±4.30, respectively; P<0.05).ConclusionsImproper sling location is one of the major causes of persistent SUI after the conventional MUS procedure. Our results demonstrate that canal TOT may be an alternative method in the treatment of persistent SUI after the conventional MUS procedure.

Surgical outcomes of anterior trans-obturator mesh and vaginal sacrospinous ligament fixation for severe pelvic organ prolapse in overweight and obese Asian women

The aim of this study is to compare the outcomes of patients who underwent surgical repair of advanced pelvic organ prolapse amongst with normal-weight, overweight and obese Asian women. Vaginal sacrospinous ligament fixation with anterior mesh repair as primary surgery was performed on 200 patients with advanced pelvic organ prolapse (POP-Q ≥ stage III). POP-Q < stage II was objective cure and subjective cure was based on POPDI-6 (questions 2 and 3). Patients completed the UDI-6, IIQ-7, POPDI-6, and PISQ-12 pre- and post-surgery. Outcome measures were observed in three categories of Asian BMI (normal weight 18.5 to 23.0 kg/m(2), overweight >23.0 to 27.5 kg/m(2), and obese ≥ 27.5 kg/m(2)). Postoperative data were available for 195 patients. Objective cure for the normal-weight, overweight, and obese were 93.0%, 92.5% and 90.6% respectively with an overall mean follow-up of 35.69 ± 18.97 months. The subjective cure was no different. All categories improved significantly with regard to anatomical outcome, UDI-6, IIQ-7, POPDI-6, PISQ-12 after primary surgery (p < 0.05) and none had recurrence requiring further surgery. However, obese patients have significantly less improvement in POPDI-6 (p <0.037) and PISQ-12 (p <0.005) compared with normal weight. There were no differences with regard to perioperative complications and the vaginal mesh exposure rate was 4.1%. There was no difference in the objective outcome of sacrospinous ligament fixation with anterior mesh repair surgery among the three Asian BMI categories; however, obese patients showed less improvement in POP symptoms and sexual function.

Infected Synthetic Mid-Urethral Sling: Mesh or Mess?

Abstract Background: Synthetic mid-urethral sling (MUS) is a commonly used procedure to relieve stress urinary incontinence. Excellent cure rates make it a surgery of choice, but bothersome mesh-related symptoms can be distressing to the patient. Case: Retropubic synthetic MUS combined with laparoscopic-assisted vaginal hysterectomy in a 46-year-old woman resulted in postoperative chronic purulent discharge from the suprapubic sinus at the exit site of the sling, and profuse vaginal discharge from mesh exposure, of 5 years' duration. Her symptoms persisted in spite of repeated abdominal surgical explorations of the sinus tract and excision of the vaginally exposed mesh. Finally, exploration with complete removal of the infected mesh gave her relief. Conclusions: Relief from chronic suprapubic sinus and vaginal mesh exposure caused by infected synthetic MUS can be achieved only with complete removal of the sling. (J GYNECOL SURG 28:288)

Delayed vaginal and urethral mesh exposure: 10 years after TVT surgery

Delayed mesh exposure after tension-free vaginal tape (TVT) procedure is rare. We report a case of mesh exposure into the vagina and urethra that developed 10 years after TVT surgery. A 58-year-old postmenopausal woman presented with mixed urinary incontinence. She was investigated, and her stress urinary incontinence was cured with a TVT procedure 10 years ago. She was then scheduled follow-up annually. Two years postsurgery, a granulation tissue was observed and excised at the vaginal incision site. Vaginal examination 10 years postsurgery showed vaginal mesh erosion 0.5 cm from urethral meatus. Cystoscopy revealed concomitant urethral erosion at the posterior urethral wall. Mesh excision was performed, and urethra and vagina were repaired in layers. Postoperative recovery was uneventful. This finding shows that, although rare, complications can occur even after 10 years of TVT surgery.

Comparison of vaginal mesh extrusion rates between a lightweight type I polypropylene mesh versus heavier mesh in the treatment of pelvic organ prolapse

The objective of the study was to compare extrusion (vaginal mesh exposure) rates in patients undergoing transvaginal prolapse repair with the trocar-based Apogee and/or Perigee devices (American Medical Systems, Minnetonka, MN, USA) using either the original type I polypropylene mesh (IntePro, American Medical Systems, Minnetonka, MN, USA) or a newer generation lightweight type I mesh (IntePro Lite, American Medical Systems, Minnetonka, MN, USA). Data were pooled from three similarly designed prospective multicenter studies evaluating the safety and efficacy of Perigee for correction of the anterior (AC) and/or Apogee to repair the posterior/apical (PC/A) compartments. The first two studies utilized IntePro (mesh density 50 g/m(2)) and the third utilized IntePro Lite (mesh density 25.2 g/m(2)). Data were pooled to form IntePro and IntePro Lite groups for comparison. Patient demographics were recorded. Risk factors for vaginal mesh exposure were also considered. Two hundred and sixty-three patients were implanted with Perigee and/or Apogee with IntePro for a total of 371 heavier mesh implants (174 Perigee, 197 Apogee) compared to 86 patients who underwent Perigee and/or Apogee with IntePro Lite for a total of 116 lightweight mesh implants (60 Perigee, 56 Apogee). Demographics and potential risk factors for extrusion were compared between the two groups. Mean follow-up was 2.0 years and similar between the two groups. In the AC, there were 234 implants, with mesh extrusion occurring in 8.0 % following IntePro compared to 5.0 % following IntePro Lite (p = 0.57). In the PA/C, there were 253 implants, with mesh extrusion occurring in 13.7 % following IntePro compared to 7.1 % following IntePro Lite (p = 0.25). Overall mesh extrusion rates in 487 implants in all compartments were found to be 11.1 % with IntePro versus 6.0 % with IntePro Lite with an estimated odds ratio of 1.93 (95 % confidence interval 0.84-4.44, p = 0.12). No statistically significant difference in extrusion rates were seen following use of IntePro versus IntePro Lite; however, the 46 % reduction in rate of mesh exposure observed in those receiving the lighter weight mesh may represent clinical importance.

Long-term follow-up of persistent vaginal polypropylene mesh exposure for transvaginally placed mesh procedures

The surgical treatment of a cystocele via the vaginal route may require the placement of a synthetic mesh below the bladder. However, the placement of a synthetic mesh via the vaginal route can be associated with specific complications, such as vaginal mesh exposure. There is a lack of data concerning the long-term follow-up of asymptomatic persistent vaginal polypropylene mesh exposure. This was a retrospective case series of nine patients presenting with persistent vaginal mesh exposure following the placement of a macroporous monofilament polypropylene mesh for cystocele treatment. Expectant management has been proposed since the patients were asymptomatic. The median follow-up duration was 121 months [interquartile range (IQR) 119-132]. The median surface area of vaginal mesh exposure (1 cm(2); IQR 1-1) did not change significantly during the follow-up. No pelvic or perineal abscess occurred during the follow-up. Only one of them was sexually active; she complained of dyspareunia at the last follow-up, but refused renewed surgery since she had sexual intercourse on only a small number of occasions per year. Clinical examination using the International Continence Society Pelvic Organ Prolapse Quantification system: Ba -3 to -2 (n = 7; 88 %), Ba -1 (n = 1; 12 %), Ba 0 or greater (n = 0). Persistent asymptomatic vaginal polypropylene mesh exposure is associated with few complications at long-term follow-up.

Traitement de la rectocèle par une prothèse biologique de derme porcin inter-rectovaginale associé à une sacropexie infracoccygienne

To evaluate an infracoccygeal colpopexy procedure by tension-free synthetic tape for vaginal apical prolapse associated with a posterior mesh procedure using porcine dermal graft for rectocele repair. A retrospective study concerning 35 women. The surgical procedure included rectocele repair with porcine dermal collagen implant (porcine dermal matrix, native) associated with transgluteal infracoccygeal sacropexy using a polypropylene sling. Median follow up was 48 months (42-54). A vaginal hysterectomy was associated in 43% and a cure of cystocele was associated in 63% of cases. No intra-operative complication was noted. The prevalence of dyschesia decreased from 25% (eight patients) preoperatively to 3% (one patient) postoperatively. No cases of de novo dyspareunia was noted. Five (14%) patients had a recurrent prolapse (two cases of rectocele stage 2, one case of grade 3 rectocele associated with a cystocele, a case of uterine prolapse associated with cystocele and one case of recurrent isolated uterine prolapse). Among them, three patients (9%) required a re-intervention for prolapse recurrence. No vaginal mesh exposure was observed. Perineal pain was reported by 12 (33%) patients at one month follow-up, but no patient complained with perineal pain one year follow-up. Infracoccygeal sacropexy associated with rectocele repair using porcine dermal collagen implant was associated with satisfactory results at medium term follow-up.

Serious Complications From a Single-Incision Midurethral Sling Placement

The single-incision midurethral sling has been introduced as an alternative to the traditional midurethral sling. Complications have been reported rarely. A 57-year-old multiparous woman with history of osteogenesis imperfecta type I underwent single-incision midurethral sling placement for stress urinary incontinence. She developed bladder mesh erosion, vaginal mesh exposure, and an urethrovaginal fistula. This case raises awareness of the potential complications that can arise after single-incision midurethral sling placement and emphasizes the importance of patient selection and preoperative evaluation before undergoing minimally invasive procedures.