Surgical management of mesh-related complications after prior pelvic floor reconstructive surgery with mesh

Tijdink, Myrthe M.; Vierhout, Mark E.; Heesakkers, John; Withagen, Mariëlla I. J.

doi:10.1007/s00192-011-1476-2

Cited by 98 publications

(96 citation statements)

References 26 publications

(43 reference statements)

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“…9,44,276 Some authors have recommended sling incision or even urethral dilatation for treatment of patients with urethral obstruction, although most authors agree that the entire suburethral portion of the sling should be removed, even if an incision into the wall or urethral lumen is required. 9,40,154,244,261 Whether to remove all of the mesh from RP slings in patients with urethral obstruction depends on multiple factors, including associated pelvic pain, dyspareunia and/or recurrent infections that might be related to retained mesh. [277][278][279][280] No meaningful data exist regarding the effectiveness of urethral dilatation; however, based on our clinical experience, we believe that this approach should not be used owing to the possibility of a urethral abrasion that might ultimately lead to erosion.…”

Section: Oab Symptomsmentioning

confidence: 99%

“…9,261 In addition, the qualifiers persistent or de novo 261 were often used. De novo OAB, indicating the occurrence of OAB after sling surgery, was reported in 0-48% of patients in various studies (REFS 17,18,20,26,39,(46)(47)(48)(50)(51)(52)(53)55,(57)(58)(59)61,62,66,67,70,(73)(74)(75)(76)(77)79,83,87,88,91,92,96,97,99,140,152,153,155,157,159,161,163,164,(166)(167)(168)(170)(171)…”

Section: Oab Symptomsmentioning

confidence: 99%

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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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Section: Oab Symptomsmentioning

confidence: 99%

Section: Oab Symptomsmentioning

confidence: 99%

Safety considerations for synthetic sling surgery

et al. 2015

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“…Conservative treatment was modeled as an alternative to sling excision with an estimated base case of 15.4%. Additionally, it was modeled that 36% of the patients who had sling excision experienced persistent SUI based on a retrospective cohort study [25]. Base case rates of developing de novo urge after initial treatment with MUS and postoperative use of anticholinergic medication when having developed urge symptoms as a consequence of MUS, was modeled after an RCT, which reported probabilities of 6.4 and 16.5%, respectively [10,26].…”

Section: Probabilitiesmentioning

confidence: 99%

“…future science group www.futuremedicine.com Probability of mesh erosion following MUS surgery 2.24% [24] Probability of mesh erosion that requires sling revision/excision 84.6% [24] Probability of cure after sling revision/excision 15.4% [24] Probability of SUI after sling revision/excision 36% [25] Probability of sustained SUI after MUS surgery 9.3% Estimated Probability of reoperation with MUS due to sustained SUI 2.4% [6] Probability of having de novo urge incontinence after insertion of MUS 6.4% [26] Probability of receiving anticholinergic medicine as treatment of de novo urge incontinence 16.5% [10] Probability of urinary retention after MUS insertion that requires release 6.01% [10] Probability of persistent SUI after sling release 13% [27] Probability of cure with IVM 68.4% [16,18,28] Probability of persistent SUI after treatment with IVM 31.6% [16,18,28] Probability of cure with MM 25% [15] Probability of persistent SUI after treatment with MM 75% [15] IVM: In vitro myoblast approach; MM: Minced myofiber approach; MUS: Midurethral sling; SUI: Stress urinary incontinence. Health utility value of no incontinence 0.93 [29] Health utility value for SUI 0.71 [29] Health utility value for treatment of de novo urge with anticholinergic medication 0.81 [29] Health utility value for de novo urge after MUS operation 0.74 [29] Health utility value for repeated MUS operation 0.89 [23,29] MUS: Midurethral sling; SUI: Stress urinary incontinence.…”

Section: Probabilitiesmentioning

confidence: 99%

Cell-based Therapy for the Treatment of Female Stress Urinary Incontinence: An Early Cost–Effectiveness Analysis

et al. 2018

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Aim:To perform an early cost-effectiveness analysis of in vitro expanded myoblasts (IVM) and minced myofibers versus midurethral slings (MUS) for surgical treatment of female stress urinary incontinence. Methods: Cost-effectiveness and sensitivity analyses were performed using a decision tree comprising previously published data and expert opinions. Results & conclusion: In the base case scenario, MUS was the cost-effective strategy with a negative incremental cost-effectiveness ratio compared with IVM and a positive incremental cost-effectiveness ratio compared with minced myofibers. However, the sensitivity analysis indicates that IVM may become an alternative providing greater effect at a higher cost. With the possibility of becoming more effective, IVM treatment would be advantageous over MUS given its reduced invasiveness and lower risks of complications. Urinary incontinence (UI) is a common medical condition that has a negative impact on the quality of life of individuals of all ages, racial and ethnic groups. The prevalence of UI is about two-to-four-times higher in women than in men, ranging from 11 to 57% [1]. The most common subtype is stress urinary incontinence (SUI), affecting roughly 50% of any women with UI [2]. SUI describes a condition where there is an involuntary leak of urine when intra-abdominal pressure rises, for example, when coughing, sneezing, laughing or during other physical activity. SUI has not only a severe impact on quality of life but it also places a substantial economic burden on the healthcare system and society [3][4][5]. In the USA, for example, it has been estimated that in 1998, the average direct medical cost of SUI amounted US$5642 per patient, while the indirect workplace expenses were US$4208 [3]. Evidence suggests that these costs have experienced an age-related increase over the last years [5].The clinical management of SUI is complex and may involve conservative treatments, such as pelvic floor muscle training and pharmacotherapy, as well as surgical procedures. Currently, the gold standard for surgical management of SUI in women is the midurethral sling (MUS), which displays a cure rate of 80-95% [6][7][8]. While MUS has a high success rate, 5-20% of the patients will have persisting incontinence thus needing to undergo sling removal and subsequent treatment [9]. The postoperative complications reach as high as 7.2% for erosion and the risk of getting a perioperative urinary tract infection is 17.2% [10]. As an alternative to MUS implantation, with the goal of targeting the underlying etiology rather than relieving the symptoms, cell-based therapies (CBTs) have recently emerged [11]. Among the different modalities of CBT, intraurethral injection of autologous skeletal myoblasts appears as one of the most promising regenerative therapies for SUI [12]. While various large-scale clinical trials are still ongoing, results from the initial clinical studies have shown that these approaches appear to be safe and moderately effective. Remarkably, a recent study has shown ...

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“…The first is the importance of lucid outcomes reporting in functional urology. Several centers have reported large series that summarize the results of removal of mesh for pain [1][2][3][4]. Of note, mesh excision is indicated not only for pain but also for other indications such as significant and symptomatic vaginal exposure; erosion into surrounding viscera (urethra, bladder, bowel); and altered functional status of vagina, bowel, or bladder.…”

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confidence: 99%