Martius Graft for the Management of Tension-Free Vaginal Tape Vaginal Erosion

We reviewed the incidence, predisposing factors, presentation and management of complications related to the use of synthetic mesh in the management of stress urinary incontinence and pelvic organ prolapse repair. Immediate complications, such as bleeding, hematoma, injury to adjacent organs during placement of mesh and complication of voiding dysfunction are not discussed in this review, since they are primarily related to technique. A PubMed search of related articles published in English was done from April 2008 to March 2011. Key words used were urinary incontinence, mesh, complications, midurethral sling, anterior prolapse, anterior vaginal repair, pelvic organ prolapse, transvaginal mesh, vault prolapse, midurethral slings, female stress urinary incontinence, mesh erosion, vaginal mesh complications, and posterior vaginal wall prolapse. Since there were very few articles dealing with the management of mesh-related complications in the period covered in the search we extended the search from January 2005 onwards. Articles were selected to fit the scope of the topic. In addition, landmark publications and Manufacturer and User Facility Device Experience (MAUDE) data (FDA website) were included on the present topic. A total of 170 articles were identified. The use of synthetic mesh in sub-urethral sling procedures is now considered the standard for the surgical management of stress urinary incontinence. Synthetic mesh is being increasingly used in the management of pelvic organ prolapse. While the incidence of extrusion and erosion with mid-urethral sling is low, the extrusion rate in prolapse repair is somewhat higher and the use in posterior compartment remains controversial. When used through the abdominal approach the extrusion and erosion rates are lower. The management of mesh complication is an individualized approach. The choice of the technique should be based on the type of mesh complication, location of the extrusion and/or erosion, its magnitude, severity and potential recurrence of pelvic floor defect.

show abstract

“…[149] Interposition of the Martius graft has been advocated in such a scenario to reduce the risk of urethrovaginal fistula. [150]…”

Section: Mesh Complicationsmentioning

confidence: 99%

Mesh complications in female pelvic floor reconstructive surgery and their management: A systematic review

2012

View full text Add to dashboard Cite

show abstract

“…Al-Wadi et al treated a 43-year-old patient having a 1x2 cm sized vaginal erosion with intravaginal estrogen for 2 months. However, because conservative management failed, they covered the t-tape with a bulbocavernous fat pad graft [10]. Conservative treatment consumes much time and martius grafting has the disadvantage of leaving an incision wound on the labia majora.…”

Section: Discussionmentioning

confidence: 99%

Vaginal Mucosal Flap as a Sling Preservation for the Treatment of Vaginal Exposure of Mesh

et al. 2010

View full text Add to dashboard Cite

PurposeTension-free vaginal tape (TVT) procedures are used for the treatment of stress urinary incontinence in women. The procedures with synthetic materials can have a risk of vaginal erosion. We experienced transobturator suburethral sling (TOT) tape-induced vaginal erosion and report the efficacy of a vaginal mucosal covering technique.Materials and MethodsA total of 560 female patients diagnosed with stress urinary incontinence underwent TOT procedures at our hospital between January 2005 and August 2009. All patients succeeded in follow-ups, among which 8 patients (mean age: 50.5 years) presented with vaginal exposure of the mesh. A vaginal mucosal covering technique was performed under local anesthesia after administration of antibiotics and vaginal wound dressings for 3-4 days.ResultsSeven of the 8 patients complained of persistent vaginal discharge postoperatively. Two of the 8 patients complained of dyspareunia of their male partners. The one remaining patient was otherwise asymptomatic, but mesh erosion was discovered at the routine follow-up visit. Six of the 8 patients showed complete mucosal covering of the mesh after the operation (mean follow-up period: 16 moths). Vaginal mucosal erosion recurred in 2 patients, and the mesh was then partially removed. One patient had recurrent stress urinary incontinence.ConclusionsVaginal mucosal covering as a sling preservation with continued patient continence may be a feasible and effective option for the treatment of vaginal exposure of mesh after TOT tape procedures.

show abstract

“…33,315-319 Treatment of urethral erosions might be as simple as excision of the mesh, which sometimes pulls easily out of the urethra, (Figure 2) or can involve extensive surgical excision of the mesh with part of the urethral wall requiring urethral reconstruction and a Martius flap (Figure 3). 320 Vaginal mesh erosion, extrusion or exposure Vaginal mesh erosion, extrusion or exposure has been reported in 0-19% of patients with a SMUS (0-11% of patients with an RP sling and 0-19% of patients with a TOT sling, 22 …”

Section: Mesh Erosions In the Urethramentioning

confidence: 98%

Safety considerations for synthetic sling surgery

et al. 2015

View full text Add to dashboard Cite

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%.

show abstract

Martius Graft for the Management of Tension-Free Vaginal Tape Vaginal Erosion

Abstract: The Martius procedure was a practical alternative for treating this patient with synthetic-mesh-induced vaginal erosion. It allowed preservation of the sling, thereby preventing recurrence of urinary incontinence.

Cited by 17 publications

References 6 publications

Mesh complications in female pelvic floor reconstructive surgery and their management: A systematic review

Mesh complications in female pelvic floor reconstructive surgery and their management: A systematic review

Vaginal Mucosal Flap as a Sling Preservation for the Treatment of Vaginal Exposure of Mesh

Safety considerations for synthetic sling surgery

Contact Info

Product

Resources

About