Controversies in the Management of Mesh-Based Complications

Marks, Brian; Goldman, Howard B.

doi:10.1016/j.ucl.2012.05.009

Cited by 23 publications

(13 citation statements)

References 35 publications

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“…There is not currently a consensus on how much mesh should be removed or how far the dissection should be carried from the exposed area. For a minimally invasive approach, only the small portion of exposed mesh is excised [50]. However, performing a formal mesh excision with removal of the mesh arms has been our practice as previously described.…”

Section: Vaginal Mesh Exposurementioning

confidence: 99%

Evaluation and Management of Mid-Urethral Sling Complications

Brown

Cohn

Kaufman

et al. 2016

Curr Bladder Dysfunct Rep

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Currently, a mid-urethral sling is the standard of care for the treatment of female stress urinary incontinence. However, complications can occur that are unique to polypropylene mesh such as mesh exposure, perforation, or contracture. Other complications such as de novo urgency and/or urgency urinary incontinence (UUI), urinary tract infection, and/or urinary obstruction can also occur. The diagnosis of these complications requires a high index of suspicion, and treatment is critical as these complications can be quite morbid. As such, this review will discuss the most recent literature regarding the intraoperative and post-operative evaluation and management of mid-urethral sling complications.

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Section: Vaginal Mesh Exposurementioning

confidence: 99%

Evaluation and Management of Mid-Urethral Sling Complications

Brown

Cohn

Kaufman

et al. 2016

Curr Bladder Dysfunct Rep

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“…30,[41][42][43]45 Mesh exposures of this type are usually reported as minor complications; post-treatment follow up in these patients has been woefully inadequate in most studies. 319,[323][324][325] We did not find sufficient justification in the literature to be able to confidently assess the long-term success of treating these minor exposures. For example, in a retrospective review of nearly 347 complications, the authors found that 73% of patients who initially had nonsurgical treatment for vaginal mesh extrusions ultimately required surgical treatment within 5 years of the original sling surgery.…”

Section: Reviewsmentioning

confidence: 93%

Safety considerations for synthetic sling surgery

et al. 2015

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Implantation of a synthetic midurethral sling (SMUS) is the most commonly performed anti-incontinence operation in women worldwide. The effectiveness of the SMUS is comparable to that of the historical gold standards--autologous fascial slings and the Burch colposuspension. Much controversy, however, has evolved regarding the safety of this type of sling. Overall, the quality of the studies with respect to assessing risks of SMUS-associated complications is currently poor. The most common risks in patients with SMUS include urethral obstruction requiring surgery (2.3% of patients with SMUS), vaginal, bladder and/or urethral erosion requiring surgery (1.8%) and refractory chronic pain (4.1%); these data likely represent the minimum risks. In addition, the failure rate of SMUS implantation surgery is probably at least 5% in patients with stress urinary incontinence (SUI). Furthermore, at least one-third of patients undergoing sling excision surgery develop recurrent SUI. Considering the additional risks of refractory overactive bladder, fistulas and bowel perforations, among others, the overall risk of a negative outcome after SMUS implantation surgery is ≥15%.

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“…Local estrogen therapy is often employed but the literature reflects mixed results [71,73]. If vaginal extrusion/ exposure is larger or fails to heal satisfactorily with conservative measures, excision should be considered [71][72][73][74]. Often a limited excision is attempted under local anesthesia in cases of small persistent areas of vaginal exposure [73,74].…”

Section: Mid-urethral Sling Exposure/extrusionmentioning

confidence: 99%

“…If vaginal extrusion/ exposure is larger or fails to heal satisfactorily with conservative measures, excision should be considered [71][72][73][74]. Often a limited excision is attempted under local anesthesia in cases of small persistent areas of vaginal exposure [73,74]. Management of MUS involving the urinary tract, termed extrusion, has been reported with excision via either the vaginal or abdominal approaches, or endoscopically with ablation with holmium laser or transurethral resection with electrocautery [75,76].…”

Section: Mid-urethral Sling Exposure/extrusionmentioning

confidence: 99%

“…In retrospect, surgical expertise with specialized training in proper patient selection, mesh insertion and management of associated complications is now advocated through credentialing processes [12,34,98]. Tightening FDA approval with more rigorous safety and efficacy testing for the licensing of new FPMRS-related surgical devices will be necessary to improve patient safety and trust [12,34,73,100]. There are still many unanswered questions in understanding vaginal tissue, the aging process and how exactly mesh placement affects the vaginal wall healing and inflammatory responses [55].…”

Section: Reviewmentioning

confidence: 99%

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Meshology: a fast-growing field involving mesh and/or tape removal procedures and their outcomes

Lee

Bacsu

Zimmern

2014

Expert Review of Medical Devices

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Stress urinary incontinence and pelvic organ prolapse are two of the commonest conditions affecting women today. It is associated with significant compromise to quality of life. Through the years, there has been an evolution of technique and graft material to augment repairs for durability. Transvaginal placements of synthetic mid-urethral slings and vaginal meshes have largely superseded traditional tissue repairs in the current era because of presumed efficacy and ease of implant with device 'kits'. The use of synthetic material has generated novel complications, including mesh extrusion, pelvic and vaginal pain and mesh contraction. In this review, our aim is to discuss the management and outcomes associated with mesh removal. In addition, we will briefly review the safety communications issued by the US FDA on transvaginal mesh placement and a new classification system for complications arising from the use of synthetic graft endorsed by both the International Continence Society and International Urogynecological Association.

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Controversies in the Management of Mesh-Based Complications

Cited by 23 publications

References 35 publications

Evaluation and Management of Mid-Urethral Sling Complications

Evaluation and Management of Mid-Urethral Sling Complications

Safety considerations for synthetic sling surgery

Meshology: a fast-growing field involving mesh and/or tape removal procedures and their outcomes

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