Managing vaginal mesh exposure/erosions

Davila, G. Willy; Jijon, Alfredo

doi:10.1097/gco.0b013e328357a1c5

Cited by 24 publications

(13 citation statements)

References 10 publications

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“…Continued biomaterial development toward lightweight, partially absorbable meshes, proper training on the product in use, and sufficient surgical volumes may further decrease the risk for mesh complications [4]. However, in contrast to postoperative pelvic pain, exposure itself is often relatively simple to handle and rarely a cause of debilitating symptoms [16].…”

Section: Discussionmentioning

confidence: 99%

Pelvic organ prolapse repair using the Uphold™ Vaginal Support System: a 1-year multicenter study

et al. 2016

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Introduction and hypothesis The objective was to assess safety and clinical outcomes in women operated on using the Uphold™ Lite Vaginal Support System. Methods We carried out a 1-year, multicenter, prospective, single cohort study of 207 women with symptomatic Pelvic Organ Prolapse Quantification (POP-Q) stage ≥2 apical pelvic organ prolapse, with or without concomitant anterior vaginal wall prolapse. Safety data were collected using a standardized questionnaire. Anatomical outcome was assessed by the POP-Q and subjective outcomes by the Pelvic Floor Distress Inventory after 2 months and 1 year using a one-way repeated measures analysis of variance. Pain was evaluated using a visual analog scale. Results The overall rate of serious complications was 4.3 % (9 out of 207 patients), including 3 patients with bladder perforations, 1 with bleeding >1,000 ml, 2 who had undergone reoperations with complete mesh removal because of pain, and 3 surgical interventions during follow-up because of mesh exposure. POP-Q stage ≤1 after 1 year was 94 % and subjective symptom relief was reported by 91 % of patients (p < 0.001). Pain after 2 months and 1 year was 60 % lower compared with the preoperative mean (p < 0.001). Minor complications occurred in 20 women (9.7 %) and were dominated by lower urinary tract dysfunction. No predisposing risk factors for complications were found. Conclusions The Uphold™ Lite procedure in women with apical pelvic organ prolapse provided satisfactory restoration of vaginal topography and symptom relief. However, serious complication rates were largely comparable with those of other transvaginal mesh kits.

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Section: Discussionmentioning

confidence: 99%

Pelvic organ prolapse repair using the Uphold™ Vaginal Support System: a 1-year multicenter study

et al. 2016

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“…110 Patients who experience postoperative pain or de novo dyspareunia directly related to the sling without exposure, should be treated conservatively with pelvic floor physical therapy, vaginal oestrogens, anti-inflammatory medications or trigger-point infiltration with steroid and anaesthetic. [110][111][112] Surgical management with partial or total mesh excision can be offered but the surgeon must be aware that total resolution of the pain is not guaranteed. 110,111,113 Overall, insufficient data are currently available to recommend any particular procedure in terms of sexual function.…”

Section: In 2012mentioning

confidence: 99%

“…Patients with vaginal exposure of a polypropylene sling can be managed conservatively with local oestrogen therapy or in-office trimming of the exposed sling if the exposure is easily reachable. 110 Surgical management (excision of the exposed sling after dissection and mobilization of the surrounding healthy vagina) is required for large or inaccessible exposure or when conservative management fails. 110 Patients who experience postoperative pain or de novo dyspareunia directly related to the sling without exposure, should be treated conservatively with pelvic floor physical therapy, vaginal oestrogens, anti-inflammatory medications or trigger-point infiltration with steroid and anaesthetic.…”

Section: In 2012mentioning

confidence: 99%

“…110 Surgical management (excision of the exposed sling after dissection and mobilization of the surrounding healthy vagina) is required for large or inaccessible exposure or when conservative management fails. 110 Patients who experience postoperative pain or de novo dyspareunia directly related to the sling without exposure, should be treated conservatively with pelvic floor physical therapy, vaginal oestrogens, anti-inflammatory medications or trigger-point infiltration with steroid and anaesthetic. [110][111][112] Surgical management with partial or total mesh excision can be offered but the surgeon must be aware that total resolution of the pain is not guaranteed.…”

Section: In 2012mentioning

confidence: 99%

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Stress urinary incontinence and LUTS in women—effects on sexual function

2014

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The sexual impact of urinary incontinence in women depends on a host of parameters, including physical, psychological, social and cultural dimensions. Evaluation of the effects of stress urinary incontinence (SUI) and lower urinary tract symptoms on sexual function is often biased by their common association with other pelvic floor disorders, such as pelvic organ prolapse, which also affect sexual satisfaction. Indeed, these complexities are reflected in the literature, which shows considerable disparity in sexual functional characteristics in women with incontinence both before and after treatment. This discordance is further emphasized by heterogeneity in study design, quality and analysis. Here, we describe the nature of sexual dysfunction in women with incontinence, including coital incontinence. The various treatments for SUI, which include transvaginal tape surgeries, can also affect sexual function, positively or negatively. Coital incontinence seems to be a good predictor of an improvement in postoperative sexual parameters: its cure, achieved by >90% of women, to a large extent explains the sexual benefits reported in several studies. By contrast, deterioration in sexual function is sometimes reported after surgery, with de novo or worsened dyspareunia being the most common cause. The literature does not contain any convincing arguments for one treatment or another on the basis of sexual functional outcome.

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“…Mesh erosion into the bladder or urethra is a long-term complication which occurs in <1 % of cases [34,35]. Risk factors for genitourinary mesh erosions include trocar injury, diabetes, hematomas, blood transfusions, smoking, increased BMI, and vaginal atrophy [36,37].…”

Section: Gynecologicmentioning

confidence: 99%

Functional Outcomes of Bladder Reconstruction Secondary to Trauma and Ureteral Injury

Faris

2015

Curr Bladder Dysfunct Rep

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Injury to the ureter and bladder are relatively rare occurrences and provoke significant diagnostic dilemmas. Etiologies include external trauma, such as automobile accidents or gunshot wounds, and iatrogenic injuries during pelvic surgery or endoscopy. When lower urinary tract injury goes unrecognized, presenting symptoms can be vague and often delay diagnosis. Such delays may result in prolonged hospital stays and deterioration of renal function and have significant impact on a patient's quality of life. Reconstruction of these injuries can be challenging depending on the mechanism and location of injury. Overall functional outcomes of reconstruction for ureteral or bladder injuries is excellent, but there is limited data on post-operative voiding function. One unique injury worth mentioning is mesh erosion into the genitourinary tract where patients may have persistent lower urinary tract symptoms after reconstruction.

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Managing vaginal mesh exposure/erosions

Cited by 24 publications

References 10 publications

Pelvic organ prolapse repair using the Uphold™ Vaginal Support System: a 1-year multicenter study

Pelvic organ prolapse repair using the Uphold™ Vaginal Support System: a 1-year multicenter study

Stress urinary incontinence and LUTS in women—effects on sexual function

Functional Outcomes of Bladder Reconstruction Secondary to Trauma and Ureteral Injury

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