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O'Kane M, Araklitis G, Rantell A, Robinson D, Cardozo L. Conservative management of intravesical erosion of a synthetic mid-urethral sling for the treatment of stress urinary incontinence, based on patient preference: A case report. Case Rep Womens Health 2022; 33:e00383. [PMID: 35127457 PMCID: PMC8810362 DOI: 10.1016/j.crwh.2022.e00383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/08/2022] [Accepted: 01/10/2022] [Indexed: 12/05/2022] Open
Abstract
Background Intravesical mesh erosion is an uncommon late complication of placement of a synthetic mid-urethral sling (MUS) for the treatment of stress urinary incontinence, and only a few cases have been reported. Optimal management remains controversial, though there is a tendency toward surgical removal through a variety of routes. However, surgical removal comes with its own risks and is not necessarily associated with an improvement in symptoms. We, herein present the first case of a conservatively managed intravesical mesh erosion following MUS placement. Case Nine years after insertion of a tension-free vaginal tape (TVT), a patient presented with persistent lower abdominal pain and dysuria. Flexible cystoscopy demonstrated an erosion of the tape through the bladder wall. The patient declined surgical intervention at the time. Therefore, she was commenced on regular methenamine hippurate and vaginal oestrogen, and kept under surveillance with regular cystoscopies. Her symptoms responded to this treatment and 6 years later remained well controlled on this regime. Conclusion This case demonstrates that conservative management may be a safe and appropriate option for patients who decline surgical excision of mesh erosion. Till recently, tension-free vaginal tape (TVT), was the most popular surgical treatment of stress urinary incontinence (SUI). Intravesical mesh erosion, though uncommon, can occur with delayed presentation. Surgical excision of mesh may not cure the presenting complaint and may cause de novo/recurrent lower urinary tract symptoms. Patients may prefer expectant/conservative management rather than surgical intervention to control symptoms caused by mesh erosion. Conservative management may be a safe alternative to surgery in patients who are willing to remain under long-term surveillance.
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Dunn AJ, Dengler KL, Gruber DD, Osborn DJ. Endoscopic management of transvaginal mesh kit bladder extrusion: A case report and literature review. JOURNAL OF CLINICAL UROLOGY 2020. [DOI: 10.1177/2051415820937193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: A rare complication of transvaginal synthetic mesh kits is bladder mesh extrusion. Treatment options include abdominal or vaginal surgical mesh excision or endoscopic mesh vaporization. There are very few published studies detailing endoscopic management. This unique case describes how repeated endoscopic mesh vaporization may be required as mesh extrusion may progress. Methods: A 71-year old female with a history of pelvic organ prolapse managed with an anterior transvaginal mesh kit presented years later with persistent urgency incontinence and recurrent acute cystitis. Cystoscopy eventually revealed bladder calculi adherent to extruded mesh. The stones and extruded mesh were vaporized using the Holmium laser on three occasions over 3 years. Results: Our approach offered a minimally invasive technique with short recovery, no use of a catheter post-operatively and maintained original prolapse repair; however, these patients may be at risk of mesh extrusion recurrence. Conclusion: Bladder extrusion of transvaginal pelvic organ prolapse kit mesh is thankfully a rare complication. With no current consensus for treatment of bladder mesh extrusion, the decision to perform complete mesh excision versus endoscopic treatment should be based on the degree and location of the extrusion, the risk of major complications, mesh extrusion recurrence and the patient’s desired outcomes, including recovery time and risk for prolapse recurrence. Endoscopic vaporization of extruded pelvic organ prolapse mesh likely has a higher recurrence rate than vaginal or abdominal excision. The risks and benefits are important to discuss during counseling and informed consent in these difficult cases. Level of evidence: 4
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Affiliation(s)
- Ariel J. Dunn
- Division of Urogynecology, Department of Obstetrics and Gynecology, Walter Reed National Military Medical Center, United States of America
| | - Katherine L. Dengler
- Division of Urogynecology, Department of Obstetrics and Gynecology, Walter Reed National Military Medical Center, United States of America
| | - Daniel D. Gruber
- Division of Urogynecology, Department of Obstetrics and Gynecology, Walter Reed National Military Medical Center, United States of America
| | - David J. Osborn
- Department of Urology, Walter Reed National Military Medical Center, United States of America
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Schaer GN, Moeltgen T, Ryu G, Magg H, Khan Z, Sarlos D. A novel combined transurethral and suprapubic approach for excision of mesh at the bladder neck. Int Urogynecol J 2019; 31:663-665. [PMID: 31654095 DOI: 10.1007/s00192-019-04110-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 08/28/2019] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Unrecognized bladder perforation of a tension-free sling is a rare situation. Removal of the intravesical sling has been done by laparotomy or transurethrally. With technique presented here we want to show a minimally invasive approach that allows complete removal of the intraluminal sling material, located at the bladder neck. METHODS This video shows a novel combined transurethral and suprapubic approach for radical removal of the mesh. Two 3.5-mm trocars were placed suprapubically into a filled bladder. One site was used for an optic with camera and the other for a 3.5-mm grasping forceps to apply tension on the mesh to pull it out of the bladder wall while it was being excised transurethrally with a cystoscope and transurethral scissors. RESULTS The patient's postoperative course was uneventful. At 1-month follow-up, the patient was free of dysuria and cystoscopy revealed complete healing of the mesh site. Because of recurrent stress urinary incontinence, another continence sling surgery has been performed (TVT exact). After a follow-up of 2 years, she is continent and free of dysuria. CONCLUSIONS This novel technique provides an effective means of removing mesh perforated into the bladder, located at the bladder neck, using a combined transurethral and suprapubic approach. The technique is minimally invasive and the applied traction allows complete removal of the intraluminal part of the mesh.
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Affiliation(s)
- Gabriel N Schaer
- Department of Obstetrics and Gynecology, Kantonsspital Aarau, 5001, Aarau, Switzerland.
| | | | - Gloria Ryu
- Department of Obstetrics and Gynecology, Kantonsspital Aarau, 5001, Aarau, Switzerland
| | - Heimo Magg
- Department of Obstetrics and Gynecology, Kantonsspital Aarau, 5001, Aarau, Switzerland
| | - Zaraq Khan
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
| | - Dimitri Sarlos
- Department of Obstetrics and Gynecology, Kantonsspital Aarau, 5001, Aarau, Switzerland
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Prolapse mesh complication: large stone on vaginal mesh extruded in the bladder. Eur J Obstet Gynecol Reprod Biol 2019; 235:131-132. [DOI: 10.1016/j.ejogrb.2019.02.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 02/08/2019] [Accepted: 02/14/2019] [Indexed: 11/23/2022]
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Baeßler K, Aigmüller T, Albrich S, Anthuber C, Finas D, Fink T, Fünfgeld C, Gabriel B, Henscher U, Hetzer FH, Hübner M, Junginger B, Jundt K, Kropshofer S, Kuhn A, Logé L, Nauman G, Peschers U, Pfiffer T, Schwandner O, Strauss A, Tunn R, Viereck V. Diagnosis and Therapy of Female Pelvic Organ Prolapse. Guideline of the DGGG, SGGG and OEGGG (S2e-Level, AWMF Registry Number 015/006, April 2016). Geburtshilfe Frauenheilkd 2016; 76:1287-1301. [PMID: 28042167 PMCID: PMC5193153 DOI: 10.1055/s-0042-119648] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Revised: 10/22/2016] [Accepted: 10/22/2016] [Indexed: 10/20/2022] Open
Abstract
Aims: The aim was to establish an official interdisciplinary guideline, published and coordinated by the German Society of Gynecology and Obstetrics (DGGG). The guideline was developed for use in German-speaking countries. In addition to the Germany Society of Gynecology and Obstetrics, the guideline has also been approved by the Swiss Society of Gynecology and Obstetrics (SGGG) and the Austrian Society of Gynecology and Obstetrics (OEGGG). This is a guideline published and coordinated by the DGGG. The aim is to provide evidence-based recommendations obtained by evaluating the relevant literature for the diagnostic, conservative and surgical treatment of women with female pelvic organ prolapse with or without stress incontinence. Methods: We conducted a systematic review together with a synthesis of data and meta-analyses, where feasible. MEDLINE, Embase, Cinahl, Pedro and the Cochrane Register were searched for relevant articles. Reference lists were hand-searched, as were the abstracts of the Annual Meetings of the International Continence Society and the International Urogynecological Association. We included only abstracts of randomized controlled trials that were presented and discussed in podium sessions. We assessed original data on surgical procedures published since 2008 with a minimum follow-up time of at least 12 months. If the studies included descriptions of perioperative complications, this minimum follow-up period did not apply. Recommendations: The guideline encompasses recommendations for the diagnosis and treatment of female pelvic organ prolapse. Recommendations for anterior, posterior and apical pelvic organ prolapse with or without concomitant stress urinary incontinence, uterine preservation options, and the pros and cons of mesh placements during surgery for pelvic organ prolapse are presented. The recommendations are based on an extensive and systematic review and evaluation of the current literature and include the experiences and specific conditions in Germany, Austria and Switzerland.
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Affiliation(s)
- K. Baeßler
- Beckenbodenzentrum, Charité Universitätsmedizin, Berlin, Germany
| | - T. Aigmüller
- Universitätsklinik für Gynäkologie und Geburtshilfe, Med Uni Graz, Austria
| | - S. Albrich
- Praxis “Frauenärzte Fünf Höfe” München, München, Germany
| | | | - D. Finas
- Evangelisches Krankenhaus Bielefeld EvKB, Bielefeld, Germany
| | - T. Fink
- Sana Klinikum Berlin Lichtenberg, Berlin, Germany
| | | | - B. Gabriel
- St. Josefʼs Hospital Wiesbaden, Wiesbaden, Germany
| | - U. Henscher
- Praxis für Physiotherapie, Hannover, Germany
| | | | - M. Hübner
- Universitätsfrauenklinik Tübingen, Tübingen, Germany
| | - B. Junginger
- Beckenbodenzentrum, Charité Universitätsmedizin, Berlin, Germany
| | - K. Jundt
- Frauenarztpraxis am Pasinger Bahnhof, München, Germany
| | | | - A. Kuhn
- Inselspital Bern, Bern, Switzerland
| | - L. Logé
- Sana Klinikum Hof GmbH, Hof, Germany
| | - G. Nauman
- Helios Klinikum Erfurt, Erfurt, Germany
| | | | - T. Pfiffer
- Asklepios Klinik Hamburg Harburg, Hamburg, Germany
| | | | - A. Strauss
- Christian-Albrechts-Universität zu Kiel, Kiel, Germany
| | - R. Tunn
- St. Hedwig Krankenhaus, Berlin, Germany
| | - V. Viereck
- Kantonsspital Frauenfeld, Frauenfeld, Switzerland
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Mishra VV, Tanvir T, Choudhary S, Goraniya N. A transvaginal removal and repair of vesicovaginal fistula due to mesh erosion. J Midlife Health 2016; 7:97-9. [PMID: 27499600 PMCID: PMC4960950 DOI: 10.4103/0976-7800.185332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Vesicovaginal fistula (VVF) is a devastating social problem. It can either result from obstetric trauma or following gynecological surgeries, malignancy, or radiation. We present a case of a 70-year-old woman who had a VVF following mesh augmentation surgery for anterior compartment prolapse. She required a transvaginal removal of the eroded mesh followed by a transvaginal repair of VVF using a Martius flap, 6 weeks later. Transvaginal removal of mesh is technically feasible and a good approach. Timing and route of surgery should be individualized.
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Affiliation(s)
- Vineet V Mishra
- Department of Obstetrics and Gynecology, IKDRC-ITS, Ahmedabad, Gujarat, India
| | - Tanvir Tanvir
- Department of Obstetrics and Gynecology, IKDRC-ITS, Ahmedabad, Gujarat, India
| | - Sumesh Choudhary
- Department of Obstetrics and Gynecology, IKDRC-ITS, Ahmedabad, Gujarat, India
| | - Nilesh Goraniya
- Department of Obstetrics and Gynecology, IKDRC-ITS, Ahmedabad, Gujarat, India
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7
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Mesh Perforation into a Viscus in the Setting of Pelvic Floor Surgery—Presentation and Management. Curr Urol Rep 2016; 17:64. [DOI: 10.1007/s11934-016-0621-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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8
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Alvarez Garzon HJ, Jacquemet B, Mottet N, Kleinclauss F, Riethmuller D, Ramanah R. Endoscopic lithotripsy and vaginal excision of a calcified bladder-mesh extrusion. Int Urogynecol J 2016; 27:1113-5. [PMID: 26740198 DOI: 10.1007/s00192-015-2934-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 12/09/2015] [Indexed: 11/27/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Synthetic meshes have proven to increase efficacy of pelvic organ prolapse (POP) repair, but associated complications are not rare. Bladder mesh extrusion is one of the most serious adverse events following POP surgery with mesh. The aim of this video was to describe endoscopic and vaginal approaches for treating a bladder-mesh extrusion. METHODS A 52-year-old female patient with a history of vaginal POP surgery with mesh was referred for severe pelvic and perineal pain, dyspareunia, and dysuria. She was found to have a bladder calculus on a mesh extrusion. The calculus was removed by endoscopic lithotripsy before vaginal mesh excision was performed. CONCLUSIONS With the use of synthetic vaginal mesh, the incidence of bladder-mesh extrusion could increase. This didactic video will be helpful to surgeons required to manage such cases using a minimally invasive treatment.
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Affiliation(s)
- H Joaquín Alvarez Garzon
- Pôle Mère-Femme, Besancon University Medical Centre, 3 Alexander Fleming boulevard, 25030, Besançon, France
| | - Baptiste Jacquemet
- Urology Department, Besancon University Medical Centre, Besancon, France
| | - Nicolas Mottet
- Pôle Mère-Femme, Besancon University Medical Centre, 3 Alexander Fleming boulevard, 25030, Besançon, France
| | | | - Didier Riethmuller
- Pôle Mère-Femme, Besancon University Medical Centre, 3 Alexander Fleming boulevard, 25030, Besançon, France
| | - Rajeev Ramanah
- Pôle Mère-Femme, Besancon University Medical Centre, 3 Alexander Fleming boulevard, 25030, Besançon, France.
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9
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Macedo FIB, O'Connor J, Mittal VK, Hurley P. Robotic removal of eroded vaginal mesh into the bladder. Int J Urol 2013; 20:1144-6. [PMID: 23600850 DOI: 10.1111/iju.12136] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Accepted: 02/05/2013] [Indexed: 11/27/2022]
Abstract
Vaginal mesh erosion into the bladder after midurethral sling procedure or cystocele repair is uncommon, with only a few cases having been reported in the literature. The ideal surgical management is still controversial. Current options for removal of eroded mesh include: endoscopic, transvaginal or abdominal (either open or laparoscopic) approaches. We, herein, present the first case of robotic removal of a large eroded vaginal mesh into the bladder and discuss potential benefits and limitations of the technique.
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Affiliation(s)
- Francisco Igor B Macedo
- Department of Surgery, St John Providence Hospital and Medical Centers, Southfield, Michigan, USA
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10
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Firoozi F, Ingber MS, Moore CK, Vasavada SP, Rackley RR, Goldman HB. Purely Transvaginal/Perineal Management of Complications From Commercial Prolapse Kits Using a New Prostheses/Grafts Complication Classification System. J Urol 2012; 187:1674-9. [DOI: 10.1016/j.juro.2011.12.066] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Indexed: 11/26/2022]
Affiliation(s)
- Farzeen Firoozi
- Glickman Urological and Kidney Institute, Center for Female Pelvic Medicine and Reconstructive Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Michael S. Ingber
- Glickman Urological and Kidney Institute, Center for Female Pelvic Medicine and Reconstructive Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Courtenay K. Moore
- Glickman Urological and Kidney Institute, Center for Female Pelvic Medicine and Reconstructive Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Sandip P. Vasavada
- Glickman Urological and Kidney Institute, Center for Female Pelvic Medicine and Reconstructive Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Raymond R. Rackley
- Glickman Urological and Kidney Institute, Center for Female Pelvic Medicine and Reconstructive Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Howard B. Goldman
- Glickman Urological and Kidney Institute, Center for Female Pelvic Medicine and Reconstructive Surgery, Cleveland Clinic, Cleveland, Ohio
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11
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Maher C, Feiner B. Laparoscopic removal of intravesical mesh following pelvic organ prolapse mesh surgery. Int Urogynecol J 2011; 22:1593-5. [PMID: 21656318 DOI: 10.1007/s00192-011-1465-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2011] [Accepted: 05/18/2011] [Indexed: 10/18/2022]
Abstract
With the increasing popularity of mesh in prolapse surgery, complications such as intravesical mesh will arise more frequently. In three cases intravesical mesh was identified in the trigone of the bladder following laparoscopic mesh hysteropexy, open sacral colpopexy, and transvaginal mesh repair and presented 9 months to 7 years later with a variety of symptoms including recurrent urinary tract infections, suprapubic pain, and constant urinary leakage. Each underwent uncomplicated laparoscopic transvesical removal of intravesical mesh. Intravesical mesh can present years following index prolapse surgery and can develop despite the bladder integrity being documented as being intact at the initial surgery. The laparoscopic approach to the removal of intravesical mesh is feasible, minimally invasive, and a precise approach to this challenging complication.
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Affiliation(s)
- Christopher Maher
- Wesley and Royal Brisbane and Women's Hospital, Brisbane, Australia.
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12
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Exposition prothétique vaginale tardive après cure de prolapsus. ACTA ACUST UNITED AC 2010; 39:672-4. [DOI: 10.1016/j.jgyn.2010.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2010] [Revised: 07/14/2010] [Accepted: 07/28/2010] [Indexed: 11/19/2022]
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13
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Current World Literature. Curr Opin Obstet Gynecol 2010; 22:430-5. [DOI: 10.1097/gco.0b013e32833f1219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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14
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Management of Complications Related to Mesh Use Within the Female Pelvis. CURRENT BLADDER DYSFUNCTION REPORTS 2010. [DOI: 10.1007/s11884-010-0056-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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15
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Bibliography: Current world literature. Female urology. Curr Opin Urol 2010; 20:343-6. [PMID: 20531093 DOI: 10.1097/mou.0b013e32833bd73a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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16
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A persistent bladder erosion with ureteric involvement following mesh augmented repair of cystocele. Am J Obstet Gynecol 2010; 202:e5-7. [PMID: 20430352 DOI: 10.1016/j.ajog.2010.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2009] [Revised: 02/22/2010] [Accepted: 03/01/2010] [Indexed: 11/22/2022]
Abstract
We present a case of a 57-year-old woman who sustained bladder erosion with extension to the left ureter after a mesh-augmented recurrent cystocele repair. The persistence of the eroding mesh eventually necessitated a partial cystectomy and distal left ureterectomy, using a Boari flap technique.
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Firoozi F, Ingber MS, Goldman HB. Pure transvaginal removal of eroded mesh and retained foreign body in the bladder. Int Urogynecol J 2010; 21:757-60. [DOI: 10.1007/s00192-009-1066-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2009] [Accepted: 11/26/2009] [Indexed: 11/29/2022]
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18
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Transvaginal Excision of Mesh Erosion Involving the Bladder After Mesh Placement Using a Prolapse Kit: A Novel Technique. Urology 2010; 75:203-6. [PMID: 19913891 DOI: 10.1016/j.urology.2009.08.052] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2009] [Revised: 08/17/2009] [Accepted: 08/20/2009] [Indexed: 11/23/2022]
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