European Urogynaecological Association Position Statement: Pelvic Organ Prolapse Surgery

Padoa, Anna; Braga, Andrea; Fligelman, Tal; Athanasiou, Stavros; Phillips, Christian; Salvatore, Stefano; Serati, Maurizio

doi:10.1097/spv.0000000000001396

Cited by 6 publications

(3 citation statements)

References 82 publications

(152 reference statements)

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“…Therefore, complete mesh removal can be challenging and risky, potentially leading to various complications. Furthermore, Padoa A et al analyzed complications and difficult pain treatment after mesh removal and reported that approximately one-third of women with pain complications showed improvement in symptoms even after complete mesh removal [ 12 ]. Our study indicated that all nine patients showed potential for bladder or rectal damage from mesh removal.…”

Section: Discussionmentioning

confidence: 99%

Evaluating Non-ablative Erbium Yttrium Aluminium Garnet (YAG) Laser Treatment for Polypropylene Mesh-Induced Vaginal Erosion: A Case Series

Okui,

Kouno,

Nakano

et al. 2024

Cureus

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Background Vaginal erosion caused by the polypropylene mesh is a serious side effect, and the development of effective treatment methods is required. This study explored the potential of non-ablative vaginal erbium yttrium aluminum garnet (YAG) laser treatment (VEL) as a novel treatment approach. Methods In this study, VEL was performed on nine women who experienced vaginal erosion after undergoing treatment for pelvic organ prolapse (POP) with polypropylene mesh. These patients visited our hospital between April and December 2020. Using the Renovalase (SP Dynamis Fotona d.o.o., Ljubljana, Slovenia), the laser was applied to the entire vagina, with intensive irradiation focused on the erosion areas. Detailed analyses of symptoms before and after treatment, as well as histopathological changes, were conducted one year post-treatment. Results Nine women were referred to our hospital due to vaginal erosion caused by polypropylene mesh. The participants' average age was 73.2 years (range: 69-81 years), with four patients having undergone transvaginal mesh (TVM) surgery and five undergoing laparoscopic sacrocolpopexy (LSC). The average time from mesh insertion to treatment initiation was 7.2 years (range: 3-15 years), with eight patients having previously attempted mesh removal. Post-treatment, significant improvements were observed in managing vaginal erosion and related bleeding, corroborated by histopathological analysis confirming cell regeneration and tissue repair. These improvements also resulted in significant improvements in bleeding management and quality of life (QoL). Conclusion VEL suggests the possibility of being an effective treatment method for vaginal erosion caused by a polypropylene mesh. However, further research is needed because of the small sample size and the limitations inherent in the retrospective case series design.

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Section: Discussionmentioning

confidence: 99%

Evaluating Non-ablative Erbium Yttrium Aluminium Garnet (YAG) Laser Treatment for Polypropylene Mesh-Induced Vaginal Erosion: A Case Series

Okui,

Kouno,

Nakano

et al. 2024

Cureus

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“…We present a case where the vNOTES approach significantly reduced postoperative pain and complications, enabling the efficient and safe removal of polypropylene mesh. To the best of our knowledge, this case report is the first to provide a detailed account of the successful application of vNOTES for mesh removal [2][3][4][5][6][7].…”

Section: Introductionmentioning

confidence: 96%

“…The removal of polypropylene mesh, a treatment for these complications, presents considerable challenges due to the risks of postoperative complications and technical difficulties [2][3][4][5]. Effective healing hinges on complete mesh removal, yet this process is fraught with complications, including severe pain and potential foreign body reactions [6,7]. These issues underscore the need for a less invasive and more precise removal technique.…”

Section: Introductionmentioning

confidence: 99%

Minimally Invasive Vaginal Natural Orifice Transluminal Endoscopic Surgery Technique for Successful Polypropylene Mesh Removal in Pelvic Organ Prolapse: A Case Report

Okui,

Okui

2024

Cureus

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In the treatment of pelvic organ prolapse, the insertion of polypropylene mesh is often necessary but can lead to subsequent complications, such as a high incidence of pain and infections, necessitating mesh removal. However, the removal of polypropylene mesh can be challenging due to the risks of postoperative complications and technical difficulties. The key to effective healing often lies in the complete removal of the mesh, but this process is associated with complications, including severe pain and potential foreign body reactions. These challenges underscore the need for less invasive and more precise removal techniques.In our clinical practice, traditional approaches, such as vaginal and open abdominal surgeries, have often been hindered by limited visibility and accessibility at the mesh fixation sites. To address these issues, our team has pioneered the development of vaginal natural orifice transluminal endoscopic surgery (vNOTES) for mesh removal. This innovative and minimally invasive technique, performed through the vaginal route, holds particular promise for repairs within the pelvic cavity. vNOTES not only enhances surgical visibility but also reduces the invasiveness of the procedure.In this case report, we present an 85-year-old female patient, who underwent transvaginal mesh (TVM) insertion at the age of 68 years. The patient developed pain in the left buttock, left lower back, and vulvar region, necessitating the removal of TVM. The vNOTES approach significantly reduced postoperative pain and complications, enabling efficient and safe removal of the polypropylene mesh. Moreover, the pathological examination of the polypropylene mesh, which was causing hip and buttock pain, revealed the presence of poor granulation tissue, indicative of a specific pathological tissue pattern. To the best of our knowledge, this is the first detailed account of the successful application of vNOTES in mesh removal.

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Intraoperative Fluorescent Ureter Visualization for Transvaginal High Uterosacral Ligament Suspension for Severe Pelvic Organ Prolapse

Barba,

Cola,

Frigerio

2024

Int Urogynecol J

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European Urogynaecological Association Position Statement: Pelvic Organ Prolapse Surgery

Cited by 6 publications

References 82 publications

Evaluating Non-ablative Erbium Yttrium Aluminium Garnet (YAG) Laser Treatment for Polypropylene Mesh-Induced Vaginal Erosion: A Case Series

Evaluating Non-ablative Erbium Yttrium Aluminium Garnet (YAG) Laser Treatment for Polypropylene Mesh-Induced Vaginal Erosion: A Case Series

Minimally Invasive Vaginal Natural Orifice Transluminal Endoscopic Surgery Technique for Successful Polypropylene Mesh Removal in Pelvic Organ Prolapse: A Case Report

Intraoperative Fluorescent Ureter Visualization for Transvaginal High Uterosacral Ligament Suspension for Severe Pelvic Organ Prolapse

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