Surgical management of bladder erosion and pelvic pain after laparoscopic lateral suspension for pelvic organ prolapse

Pelvic floor ultrasound evaluation in the diagnosis of exposure of synthetic implanted materials in the lower urinary tract

OBJECTIVE

To evaluate the diagnostic performance of pelvic floor ultrasound (PFUS) to recognize prosthetics exposure in the bladder and/or urethra in women with lower urinary tract symptoms (LUTS).

METHODS

A cross-sectional study evaluating patients with LUTS after mesh/sling surgery. PFUS was performed with both transvaginal (TVUS) and translabial (TLUS) approaches. A distance of 1 mm or less from the bladder and/or urethra was considered highly suspect for mesh exposure. After PFUS, patients underwent diagnostic urethrocystoscopy.

RESULTS

A total of 100 consecutive women were analyzed. According to urethrocystoscopy, the rate of tape exposure in the lower urinary tract was 3%. PFUS showed 100% sensitivity and 98%-100% specificity in detecting lower urinary tract mesh exposure. The negative predictive value was 100% and the positive predictive value ranged from 33% to 50% for urethral and 100% for bladder exposure.

CONCLUSIONS

PFUS represents an effective and reliable non-invasive screening test to exclude prosthetics exposure in the bladder and/or urethra in women with LUTS.

Pelvic pain after laparoscopic lateral suspension for pelvic organ prolapse: an unrecognized problem?

INTRODUCTION AND HYPOTHESIS

The laparoscopic lateral suspension (LLS) represents an alternative mesh procedure to avoid the dissection at the promontory. However, mesh-related complications such as chronic pelvic pain, dyspareunia, and bladder pain are emerging. The present study is aimed to present a video case report and describe a small case series of patients referred to our center for chronic pelvic pain after LLS.

METHODS

A surgical video of the management of a 50-year-old woman with chronic abdominal and pelvic pain, dyspareunia, and recurrent urinary tract infection (UTIs) after uterus sparing LLS is provided. Moreover, we performed a retrospective chart review of similar cases in our institution.

RESULTS

The featured procedure was completed without complications and was successful in obtaining symptom relief. Between 2018 and 2022 five patients underwent total or subtotal mesh removal for pain-related symptoms after LLS. At the median follow-up of 24 months, all patients were free from pain, but two (40%) required reoperation for prolapse recurrence CONCLUSIONS: Our experience suggests that LLS involves a certain risk of chronic pelvic pain, which may be challenging to manage and require surgical treatment.

Laparoscopic synthetic mesh explantation after sacrohysteropexy

INTRODUCTION

In this video, we present a case of rectal and bladder injury, which occurred during laparoscopic mesh removal following sacrohysteropexy treated 6 months later with a laparoscopic pectopexy.

METHODS

We present the case of a 66-year-old woman with a prolapse recurrence after sacrohysteropexy. During the laparoscopic explantation of the mesh, we detected a fixation of the mesh to the bladder and the rectum rather than a fixation to the vaginal walls. Consequently, bladder and rectal injuries occurred during the dissection and were diagnosed and repaired immediately. Due to bowel injury, the treatment of the prolapse was postponed. Six months later, a laparoscopic pectopexy was performed to avoid complications during the repeated dissection of the promontory. The postoperative recovery after the pectopexy was uncomplicated with no short-term prolapse recurrence or postoperative complications.

CONCLUSION

Laparoscopy appears to be an efficient approach to mesh explantation. Futhermore, laparoscopic pectopexy seems to be a good approach to secondary prolapse reconstruction after sacrohysteropexy mesh explantation avoiding complications during repeated dissection of the promontory.