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Perrouin‐Verbe M, Ochoa D, Skews R, Acharya M, Prouza A, Hashim H. Quality of life outcomes after transobturator tape full removal surgeries: A monocentric experience. BJUI COMPASS 2024; 5:454-464. [PMID: 38751946 PMCID: PMC11090767 DOI: 10.1002/bco2.317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 11/13/2023] [Indexed: 05/18/2024] Open
Abstract
Objective The objective of this study is to describe a standardised technique of full TOT removal with groin dissection and to report clinical improvement, satisfaction, safety and long-term functional, quality of life (QoL) and sexual QoL outcomes. Materials and methods A retrospective review enrolling all women who had full TOT removal, in a tertiary referral centre from May 2017 to November 2020. Functional outcomes, satisfaction and QoL were assessed using a bespoke composite questionnaire (UDI-6, EQ-5D-5L and ICIQ-S) with additional questions on sexual QoL. Secondary outcomes were post-operative recurrent stress urinary incontinence (SUI) and complication rate according to the Clavien-Dindo classification. Results Full TOT removal using a vaginal approach and bilateral groin/para-labial incisions was performed in 67 patients. Chronic pelvic pain was the main indication for mesh removal (51% of cases, n = 34). QoL questionnaires were answered by 43 patients. The satisfaction rate was high 86% (n = 37), and 81% (n = 35) of the patients considered the surgery successful. Seventy per cent (n = 30) of patients returned to having a sexual life after surgery. Recurrent SUI was reported in 32% (n = 14) of cases. The complication rate was 10% (7/67), all of them Clavien-Dindo ≤2. Conclusion Despite a high rate of postoperative bothersome SUI, full TOT removal with bilateral groin dissection improves pain and QoL. It is associated with a high overall satisfaction rate and an acceptable rate of complications.
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Affiliation(s)
| | | | - Rachel Skews
- Bristol Urological InstituteSouthmead HospitalBristolUK
| | - Mez Acharya
- Department of Trauma and Orthopaedic SurgerySouthmead HospitalBristolUK
| | | | - Hashim Hashim
- Bristol Urological InstituteSouthmead HospitalBristolUK
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2
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Okui N. The Potential of Non-ablative Erbium (YAG) Laser Treatment for Complications After Midurethral Sling Surgery: A Narrative Review. Cureus 2024; 16:e58486. [PMID: 38638175 PMCID: PMC11024877 DOI: 10.7759/cureus.58486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2024] [Indexed: 04/20/2024] Open
Abstract
Midurethral sling (MUS) surgery, using tension-free vaginal tape and transobturator tape, has been widely adopted for the treatment of stress urinary incontinence (SUI). However, postoperative complications, including persistent urinary incontinence, mesh exposure, and pain, have become problematic, and surgical treatments for these complications face challenges, such as invasiveness, treatment-resistant cases, and recurrence. This review provides an overview of the current evidence regarding these complications and the potential of vaginal non-ablative erbium (YAG) laser (VEL) treatment as a minimally invasive option with low risk of complications. Studies have suggested the effectiveness of VEL treatment, performed using devices such as IncontiLase (SP Dynamis; Fotona d.o.o., Ljubljana, Slovenia), for persistent urinary incontinence after MUS surgery, pain following mesh removal, and asymptomatic mesh exposure. VEL treatment is expected to be a new treatment option for complications following MUS surgery; however, further large-scale comparative trials are required to verify its efficacy and safety and to establish criteria for its indications. Appropriate assessment of the indications and provision of sufficient information to patients is important when presenting VEL as a treatment option.
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Affiliation(s)
- Nobuo Okui
- Dentistry, Kanagawa Dental University, Kanagawa, JPN
- Urology, Yokosuka Urogynecology and Urology Clinic, Kanagawa, JPN
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3
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Palmieri S, Kuria E, Gonzales G, Sarfoh R, Elneil S. Postoperative outcomes and urodynamic findings after continence mesh removal. Int J Gynaecol Obstet 2024; 164:334-338. [PMID: 37571911 DOI: 10.1002/ijgo.15051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 07/26/2023] [Accepted: 07/29/2023] [Indexed: 08/13/2023]
Abstract
OBJECTIVE To analyze urodynamics findings and patient-reported outcomes after removal of a mid-urethral mesh because data regarding outcomes following mesh removal vary in different studies, and mesh removal itself may have risks. METHODS Women who were referred to the Female Pelvic Medicine and Reconstructive Surgery Department of University College London Hospital and underwent vaginal removal of a continence mesh between January 2014 and January 2020, were included. Patient clinical data and results of video-urodynamics investigations performed 4 months after mesh removal were collected and analyzed retrospectively. RESULTS In all, 204 patients were included in the study. After mesh removal, 80.5% of patients reported recurrent stress urinary incontinence (SUI), 10.1% reported prolapse symptoms, 8% reported voiding dysfunction and 2.9% reported overactive bladder (OAB) symptoms. Video-urodynamics investigations confirmed the presence of SUI (67.6%), mixed urinary incontinence (14.3%), detrusor overactivity (DO) (6.8%) and voiding dysfunction in one patient. In two women a urethral stricture was described, and 10 women were deemed to have a significant cystocele. CONCLUSION Recurrence of SUI was the most frequent finding after continence mesh removal, both symptomatically and objectively. Women seldom reported OAB symptoms, but urodynamics showed evidence of DO despite this. On the other hand, voiding dysfunction was often reported but less often proven on urodynamics.
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Affiliation(s)
- Stefania Palmieri
- London Complex Mesh Centre, Directorate of Women's Health, University College London Hospitals NHS Foundation Trust, London, UK
| | - Esther Kuria
- Female Pelvic Medicine and Reconstructive Surgery Research Group, Institute for Women's Health, Faculty of Population Sciences, University College London, London, UK
| | - Gwendoline Gonzales
- Female Pelvic Medicine and Reconstructive Surgery Research Group, Institute for Women's Health, Faculty of Population Sciences, University College London, London, UK
- Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Raymond Sarfoh
- London Complex Mesh Centre, Directorate of Women's Health, University College London Hospitals NHS Foundation Trust, London, UK
| | - Sohier Elneil
- London Complex Mesh Centre, Directorate of Women's Health, University College London Hospitals NHS Foundation Trust, London, UK
- Female Pelvic Medicine and Reconstructive Surgery Research Group, Institute for Women's Health, Faculty of Population Sciences, University College London, London, UK
- Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, London, UK
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Okui N, Okui MA. Mesh Extraction Surgery and Laser Treatment for Pain After Mid-Urethral Sling Surgery: A Case Series. Cureus 2024; 16:e51431. [PMID: 38169735 PMCID: PMC10758587 DOI: 10.7759/cureus.51431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2023] [Indexed: 01/05/2024] Open
Abstract
Stress urinary incontinence (SUI) is the leakage of urine due to abdominal pressure. The primary surgical approach involves the insertion of a mid-urethral sling (MUS) with a mesh, which can occasionally lead to post-operative pain. To address complications, MUS removal is often necessary. We hypothesize that a non-ablative erbium:yttrium aluminum garnet (Er:YAG) laser combined with vagina (vaginal erbium laser (VEL)) and urethra (urethra erbium laser (UEL)) treatments could be a post-MUS removal option. A study involving laser treatment started in 2016 for women with recurrent SUI one year after MUS removal who were not affected by pelvic floor muscle exercises and who did not wish to have MUS reinsertion or urethral injection treatment. Five patients (mean age, 54.5 ± 9.35 years) were enrolled, all receiving laser therapy. The visual analog scale (VAS) was used to assess pain as a primary endpoint, and the one-hour pad test was performed for SUI as a secondary endpoint. The mean pain VAS score changed from 8.57 ± 0.69 to 2.29 ± 1.50 (p = 0.00002) after MUS removal. Furthermore, the VAS score was 0 (p = 0.0034) after VEL + UEL. SUI changed from 4.42 ± 2.9 g on the one-hour pad test during MUS insertion to 66.7 ± 39.0 (p = 0.005) after removal. However, after the VEL + UEL treatment, it was 3.71 ± 5.25 g (p = 0.0035). The pathological tissue collected from the five patients at the time of MUS removal surgery had vacuolization in the part where the artificial material was present in the specimen, with foreign-body giant cells proliferated around it. One year after the MUS removal, mucous membrane regeneration was poor, and tissue thickness was thin. One year after the VEL + UEL treatment, the tissue had normalized mucosa, and there was no inflammation. Our study suggests MUS extraction and VEL + UEL as viable options for treating MUS pain in women.
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Affiliation(s)
- Nobuo Okui
- Department of Dentistry, Kanagawa Dental University, Kanagawa, JPN
| | - Machiko Aurora Okui
- Department of Urology, Dr. Okui's Urogynecology and Urology Clinic, Kanagawa, JPN
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Anglim B, Zhao ZY, Parshad S, Matelski J, Lemos N. Pain resolution and functional outcomes of total mesh excision: a case series. Int Urogynecol J 2023; 34:2115-2123. [PMID: 37004520 DOI: 10.1007/s00192-023-05516-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 03/04/2023] [Indexed: 04/04/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to assess the impact of total excision of polypropylene midurethral slings (MUS) on patient pain levels and to report on functional outcomes including recurrent/de novo stress urinary incontinence (SUI), sexual function, and quality of life measures. METHODS This is a retrospective analysis of patients who underwent total MUS excision from March 2017 to December 2019. The primary outcome was the impact on pain assessed by a Numeric Rating Scale (NRS). Questionnaires analyzed were: Pain Catastrophizing Scale, Pelvic Floor Distress Inventory Short Form-20, Female Sexual Function Index, and McGill Pain Index questionnaires. RESULTS Thirty-two women underwent total mesh excision within the inclusion period; with follow-up data available for 31 out of 32; 14 (43.8%) had previously undergone one or more partial vaginal mesh excision procedures. Types of MUS removed were: 14 (43.8%) transobturator midurethral slings, 12 (37.5%) retropubic midurethral slings, 4 (12.5%) mini-slings, and 2 (6.3%) mesh slings placed by laparotomy. Pain was the main reason for referral in 31 patients (96.9%). Mean pain NRS reduced from 6.1 pre-operatively to 3.3 post-operatively, with paired comparison showing a significant difference (p<0.01). Qualitatively, complete symptoms resolution was observed in 10 out of 31 (32.3%), another 9 out of 31 (29.0%) patients experienced clinically significant improvement, 2 out of 31 (6.5%) did not experience improvement in pain, and 10 out of 31 (32.3%) reported new/worsening pain. Post-operative complications occurred in 9 (29.0%) patients; all were Clavien-Dindo grade II. Nineteen (61.3%) reported de novo/recurrent SUI post-operatively. CONCLUSION Total MUS mesh excision yields high complication and SUI recurrence rates, counter-balanced by a 61.3% pain resolution/improvement rate. These data are pertinent for patient counseling.
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Affiliation(s)
- Breffini Anglim
- Division of Female Pelvic Medicine and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, 700 University Avenue, Room 8-917, Mount Sinai Hospital, Toronto, Ontario, Canada.
| | - Zi Ying Zhao
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Shruti Parshad
- Division of Female Pelvic Medicine and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, 700 University Avenue, Room 8-917, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - John Matelski
- Division of Female Pelvic Medicine and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, 700 University Avenue, Room 8-917, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Nucelio Lemos
- Division of Female Pelvic Medicine and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, 700 University Avenue, Room 8-917, Mount Sinai Hospital, Toronto, Ontario, Canada
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6
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Abbas N, Virdee T, Basu M, Iles D, Kanitkar S, Kearney R, Khan H, Ward K, Reid F. Clinical outcomes after total excision of transobturator tape inserted for treatment of stress urinary incontinence. Neurourol Urodyn 2023; 42:785-793. [PMID: 36825383 DOI: 10.1002/nau.25155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/14/2022] [Accepted: 02/08/2023] [Indexed: 02/25/2023]
Abstract
INTRODUCTION Midurethral tapes (MUTs) were the most common surgical treatment for stress urinary incontinence (SUI) between 2008 and 2017. Transobturator tapes were introduced as a novel way to insert MUTs. Some women have experienced life-changing complications, and opt to undergo a total excision of transobturator tape (TETOT). There is a paucity in evidence about the outcomes of TETOT, which is a complex operation. This study aims to report clinical outcomes of all women who underwent TETOT in a specialist mesh center. METHODS All women between 2017 and 2022 who underwent TETOT in one mesh center were reviewed. Background demographics and preoperative symptoms were recorded retrospectively. Outcome data were collected using patient global impression of improvement (PGI-I) scales via telephone review and analyzed using SPSS 25. RESULTS Forty-five women underwent telephone review in May 2022, on average 27.9 months (range: 3-60) after TETOT. Mean age was 55 and body mass index (BMI): 30; 82% were postmenopausal, 20% were smokers, and 73.3% had recurrent SUI before excision. Indications for excision were infection (4%), vaginal exposure (24%), urethral perforation (9%), and chronic pain not associated with other complications (60%). Two women with recurrent SUI opted for a concomitant fascial sling; both reported a PGI of "very much improved" regarding SUI postoperatively. Only 12 women (26.5%) did not have SUI before excision; of these 9 (75%) reported new SUI postoperatively. Pain improved for 57.8%, but worsened for 24.4%. Although not statistically significant (p = 0.055), more women who underwent TETOT for pain alone reported worsening pain than those with pain with an additional complication (37% vs. 5.55%). Overall, 62.2% women felt "better" after their excision, 17.8% felt "worse." DISCUSSION After TETOT, 62% of women felt better. Improvement in pain was reported by 58%-those with chronic pain without another complication reported improvement in pain less frequently (48% vs. 72%) and worsening pain more frequently (37% vs. 6%). Existing SUI worsened in 65% of women and 75% developed new SUI. There appears to be discordance between reporting global improvement with worsening of commonly measured clinical outcomes. CONCLUSION Outcome data are important for counseling women about the risks and benefits of TETOT. Women and clinicians may have different attitudes to the possible benefits of TETOT, as evidenced by women reporting feeling better despite continuing pain or SUI. Conventional outcome measures do not adequately capture all outcomes that are important to patients.
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Affiliation(s)
- Nazish Abbas
- Warrell Unit, Saint Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK.,Manchester Academic Health Science Centre, Manchester, UK.,Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Tonicka Virdee
- The School of Medical Sciences, University of Manchester, Manchester, UK
| | - Maya Basu
- Warrell Unit, Saint Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK.,Manchester Academic Health Science Centre, Manchester, UK.,Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - David Iles
- Warrell Unit, Saint Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK.,Manchester Academic Health Science Centre, Manchester, UK
| | - Surya Kanitkar
- Department of Plastic Surgery, Manchester University NHS Foundation Trust, Manchester, UK
| | - Rohna Kearney
- Warrell Unit, Saint Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK.,Manchester Academic Health Science Centre, Manchester, UK.,Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Hamayun Khan
- Department of Plastic Surgery, Manchester University NHS Foundation Trust, Manchester, UK
| | - Karen Ward
- Warrell Unit, Saint Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK.,Manchester Academic Health Science Centre, Manchester, UK
| | - Fiona Reid
- Warrell Unit, Saint Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK.,Manchester Academic Health Science Centre, Manchester, UK.,Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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Todd J, Aspell JE, Lee MC, Thiruchelvam N. How is pain associated with pelvic mesh implants measured? Refinement of the construct and a scoping review of current assessment tools. BMC Womens Health 2022; 22:396. [PMID: 36180841 PMCID: PMC9523957 DOI: 10.1186/s12905-022-01977-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 09/14/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Recommendations for the management of pain related to pelvic mesh implants are still under development. One limitation that has impeded progress in this area is that mesh-related pain has not been consistently defined or measured. Here, we reviewed the ways in which pain associated with pelvic mesh implants has been measured, and mapped the ways in which these existing measures capture the construct. METHODS First, we reviewed existing accounts of the pain associated with pelvic mesh implants to develop a multifaceted construct definition, which includes aspects related to pain intensity, timing, body location, phenomenological qualities, impact/interference with daily living, and patient expectations and beliefs. Next, we reviewed the ways that the construct has been measured in the extant literature. RESULTS Within 333 eligible studies, 28 different assessments of pain associated with pelvic mesh were identified, and 61% of studies reported using more than one measurement tool. Questionnaire measures included measures designed to assess urological and/or pelvic symptoms, generic measures and unvalidated measures. We did not identify any validated questionnaire measures designed to assess pain associated with pelvic mesh implants. The phenomenological, location, and expectation/belief components of the construct were not captured well by the identified questionnaire measures, and there is no evidence that any of the identified measures have appropriate psychometric properties for the assessment of pain related to pelvic mesh implants. CONCLUSIONS We recommend further qualitative research regarding women's experiences of pelvic mesh-related pain assessment, and the development of a condition-specific patient reported outcome measure.
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Affiliation(s)
- Jennifer Todd
- School of Psychology and Sport Science, Anglia Ruskin University, East Road, Cambridge, Cambridgeshire, CB1 1PT, UK.
- Centre for Psychological Medicine, Perdana University, Serdang, Malaysia.
| | - Jane E Aspell
- School of Psychology and Sport Science, Anglia Ruskin University, East Road, Cambridge, Cambridgeshire, CB1 1PT, UK
| | - Michael C Lee
- Department of Medicine, University of Cambridge, Cambridge, UK
- Department of Anaesthesia, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Nikesh Thiruchelvam
- Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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8
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Sato H, Sato K, Mochida J, Takahashi S, Tsukada S. Postoperative indications for further surgery following post-transvaginal Prolift TM mesh repair after a two-year follow-up period: a single-centre study. J OBSTET GYNAECOL 2022; 42:2115-2120. [PMID: 35166189 DOI: 10.1080/01443615.2022.2033184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
We investigated the frequency of further surgery post-artificial mesh (ProliftTM) repair of pelvic organ prolapse. In total, 257 patients who underwent ProliftTM repair were evaluated for further surgery frequency, clinical outcomes, and demographic characteristics. Thirty-eight (14.7%) patients underwent further surgery (median time to reoperation, 9.5 months; range, 6-22 months). Six (2.3%) patients underwent prolapse repair at a different (5 patients, 1.9%) or same site (1 patient, 0.3%). One underwent posterior ProliftTM repair; four, laparoscopic sacrocolpopexy; and one, vaginal hysterectomy. Eight (3.1%) underwent surgery for complications; seven (2.7%) required further surgery for mesh exposure (median, 8 months) and one (0.3%) required further surgery for mesh infection (1 month). Twenty-four (9.3%) received further surgery for stress urinary incontinence (median, 8.5 months). Despite the low frequency of further surgery post-ProliftTM repair, mesh-related complications should be considered. Careful long-term follow-up is necessary.Impact StatementWhat is already known on this subject? It is widely known that vaginal mesh is used as treatment for pelvic organ prolapse (POP). Vaginal mesh is one of the treatment options for POP. However, it received a bad reputation following reports of complications associated with its use, leading to discontinuation of vaginal mesh in many countries.What the results of this study revealed? The findings of this study show that few patients who received ProliftTM repair required further surgery. The surgeries included surgery for non-POP-related conditions; subsequent surgery for stress urinary incontinence (SUI); surgery for complications including mesh exposure and infection; primary prolapse surgery for a different site and repeat surgery; and a repeat operation for prolapse arising from the same site.What are the implications of these findings in clinical practice and/or further research? Based on the outcome of this study, transvaginal ProliftTM mesh repair is a reasonably safe and effective treatment for POP. Despite withdrawal of all mesh products from the market as instructed by the FDA, this study suggested the need to re-evaluate the role of vaginal mesh as a treatment option for POP.
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Affiliation(s)
- Hirotaka Sato
- Department of Urology, Hokusuikai Kinen Hospital, Ibaraki, Japan
| | - Katsuhiko Sato
- Department of Urology, Eastern Oomiya Medical Center, Saitama, Japan
| | - Junichi Mochida
- Department of Urology, Nihon university school of medicine, Tokyo, Japan
| | - Satoru Takahashi
- Department of Urology, Nihon university school of medicine, Tokyo, Japan
| | - Sachiyuki Tsukada
- Department of Orthopaedic Surgery, Hokusuikai Kinen Hospital, Ibaraki, Japan
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9
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Surgical Removal of Midurethral Sling in Women Undergoing Surgery for Presumed Mesh-Related Complications: A Systematic Review. Obstet Gynecol 2022; 139:277-286. [PMID: 34991142 DOI: 10.1097/aog.0000000000004646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 10/21/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess whether some, or all, of the mesh needs to be removed when a midurethral sling is removed for complications. DATA SOURCES A systematic review and meta-analysis was conducted. MEDLINE, Cochrane, and ClinicalTrials.gov databases from January 1, 1996, through May 1, 2021, were searched for articles that met the eligibility criteria with total, partial, or a combination of anti-incontinence mesh removal. METHODS OF STUDY SELECTION All study designs were included (N≥10), and a priori criteria were used for acceptance standards. Studies were extracted for demographics, operative outcomes, and adverse events. Meta-analysis was performed when possible. TABULATION, INTEGRATION, AND RESULTS We double-screened 11,887 abstracts; 45 eligible and unique studies were identified. Thirty-five were single-group studies that evaluated partial mesh removal, five were single-group studies that evaluated total mesh removal, and five were studies that compared partial mesh removal with total mesh removal. All of the studies were retrospective in nature; there were no randomized controlled studies. Comparative studies demonstrated that partial mesh removal had lower rates of postoperative stress urinary incontinence (SUI) than total mesh removal (odds ratio 0.46, 95% CI 0.22-0.96). Single-group studies supported lower rates of postoperative SUI with partial mesh removal compared with total mesh removal (19.2% [95% CI 13.5-25.7] vs 48.7% [95% CI 31.2-66.4]). Both methods were similar with respect to associated pain, bladder outlet obstruction, mesh erosion or exposure, and lower urinary tract symptoms. Adverse events were infrequent. CONCLUSION Postoperative SUI may be lower with partial mesh removal compared with total mesh removal. Other outcomes were similar regardless of the amount of mesh removed. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD 42018093099.
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10
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Mengerink BB, Aourag N, Kluivers KB, Notten KJB, Heesakkers JPFA, Martens FMJ. Pain after midurethral sling; the underestimated role of mesh removal. Cent European J Urol 2022; 74:541-546. [PMID: 35083074 PMCID: PMC8771130 DOI: 10.5173/ceju.2021.138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 09/27/2021] [Accepted: 10/04/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction The primary aim of this study was to evaluate the results of midurethral sling (MUS) removal in women who have pain as their single complication of MUS. Material and methods We performed a retrospective chart study supplemented with a cross sectional questionnaire. Women who underwent MUS removal for pain as the solitary reason for removal between 2004 and 2018 were included. Primary outcome was change in pain levels assessed by the visual analogue scale (VAS) pain score (range 0–10). Secondary outcome was the recurrence of stress urinary incontinence (SUI). Results Twenty-six of 31 patients returned the questionnaire. Median medical file follow-up was 12 months (range 2–66) and 25 months (range 5–104) regarding questionnaires. VAS pain score dropped from 7.8 (SD 1.9) at baseline to 4.5 (SD 3.2) at follow-up (p <.00). Seven (23%) patients were pain-free. Patients undergoing partial vaginal resection (n = 6) had a VAS pain score decrease of 4.7 (p = .02) versus 2.7 (p = .02) for complete vaginal removal (n = 14). Twenty-three (89%) patients experienced SUI at follow-up, whereof 10 (45%) reported (almost) no incidents of SUI. Conclusions MUS removal is a viable and safe option with a significant drop in VAS pain score in patients with chronic pain after MUS placement. A post-operative increase of SUI and a possible renewed wish for SUI treatment have to be considered. This should not be a reason to refrain from information and/or referral for surgical removal.
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Affiliation(s)
- Bianca B Mengerink
- Department of Obstetrics and Gynaecology, Bernhoven, Uden, The Netherlands.,Department of Obstetrics and Gynaecology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Nassim Aourag
- Department of Urology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Kirsten B Kluivers
- Department of Obstetrics and Gynaecology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Kim J B Notten
- Department of Obstetrics and Gynaecology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | | | - Frank M J Martens
- Department of Urology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
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11
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Zeng J, Bergersen A, Price E, Callegari M, Austin E, Oduyemi O, Poling K, Hsu CH, Funk J, Twiss C. Symptom Resolution and Recurrent Urinary Incontinence Following Removal of Painful Midurethral Slings. Urology 2022; 159:78-82. [PMID: 34474043 DOI: 10.1016/j.urology.2021.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 08/14/2021] [Accepted: 08/17/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To evaluate pain improvement and recurrent stress incontinence (SUI) following painful synthetic midurethral sling (MUS) removal. METHODS We conducted a retrospective review of patients who underwent synthetic MUS removal at our institution from 2009-2016 for the indication of pain. We recorded sling type (transobturator vs retropubic), complete vs partial removal, and presenting symptoms. Postoperative pain improvement was categorized as resolved (pain resolved, requiring no further therapy), improved (pain less bothersome, may require further therapy), or unresolved (no/minimal improvement, requiring further management). Recurrent incontinence and further reconstructive procedures were assessed. RESULTS 87 patients (49 complete and 38 partial removal) with pain as the primary indication for removal were included. Median age at intervention was 54 years with median follow-up of 8 months. Overall, pain improved or resolved in 78.1% of cases. Complete removal was associated with significantly greater percentage of pain resolution (63.3%) compared to partial removal (26.3%) (P = 0.002) regardless of sling type. No significant differences in recurrent SUI were noted in complete vs partial removal. Additional reconstructive procedures were performed in 28 patients, most commonly sling placement, with no significant difference in complete (20.4%) vs partial (28.9%) removal groups (P = 0.36). The overall complication rate was low (5.7%), a majority of which were transfusions (4.6%). CONCLUSION Following MUS removal, most patients experienced resolution or improvement of pain. Complete sling removal was associated with significantly greater percentage of pain resolution compared to partial removal in both retropubic and transobturator slings. Rates of recurrent SUI and reintervention for SUI were not related to the extent of sling removal.
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Affiliation(s)
- Jiping Zeng
- Department of Urology, University of Arizona College of Medicine, Tucson, Arizona
| | - Andrew Bergersen
- Department of Urology, University of Arizona College of Medicine, Tucson, Arizona
| | - Elinora Price
- Department of Urology, University of Arizona College of Medicine, Tucson, Arizona
| | | | - Evan Austin
- Department of Urology, University of Arizona College of Medicine, Tucson, Arizona
| | - Odutoyosi Oduyemi
- Department of Urology, University of Arizona College of Medicine, Tucson, Arizona
| | - Kristi Poling
- Department of Urology, University of Arizona College of Medicine, Tucson, Arizona
| | - Chiu-Hsieh Hsu
- Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona
| | - Joel Funk
- Department of Urology, University of Arizona College of Medicine, Tucson, Arizona
| | - Christian Twiss
- Department of Urology, University of Arizona College of Medicine, Tucson, Arizona.
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Mesh Sling Arm Removal for Persistent Pain After an Initial Vaginal Suburethral Mesh Sling Removal Procedure. Female Pelvic Med Reconstr Surg 2021; 27:e522-e527. [PMID: 33208654 DOI: 10.1097/spv.0000000000000981] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Pain is a recognized complication of mid-urethral slings (MUS), which may lead to suburethral sling removal (SSR) alone, or to a more extensive removal approach. We report on the outcomes of women who required an SSR or an additional secondary MUS arm removal for pain only. METHODS After Institutional Review Board (IRB) approval, the charts of nonneurogenic women who underwent SSR for pain only were reviewed. Demographic information, MUS type, self-reported pain resolution, and preoperative and postoperative questionnaires, including Urogenital Distress Inventory-Short form question 6 (UDI-6 Q6) scores, were collected for the SSR (group 1) and secondary removal (group 2) groups. RESULTS Of 52 women who underwent SSR for pain only between 2005 and 2018, 16 (31%) required a secondary procedure to remove the extension arms due to persistent pain after SSR. All women in group 2 experienced pain immediately after SSR (UDI-6 Q6 score of 2 to 3). Patients whose pain improved after SSR presented at a median 61 months after MUS whereas those in group 2 underwent SSR at median 34 months after MUS. Median duration of follow-up in group 2, after the secondary procedure, was 34 months. Over one half of those in group 2 (54%) noticed pain cure/improvement. Seven were left with persistent pain. CONCLUSIONS In women who underwent SSR for pain only, 67% reported pain resolution. An additional procedure to remove the extension arms of the mesh was performed in one third of women for persistent pain after SSR.
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13
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Wang CN, Christie AL, Zimmern PE. Sensitivity to Change of Subdomain Question 6 of the Urogenital Distress Inventory Short Form After Sling Removal for Pain. Urology 2020; 147:104-108. [PMID: 33137350 DOI: 10.1016/j.urology.2020.10.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/19/2020] [Accepted: 10/20/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine the sensitivity to change of question 6 (Q6) of the modified short form version of the Urogenital Distress Inventory (UDI-6) before and after synthetic sling removal (SSR). METHODS Following IRB approval, a prospectively maintained database of mid-urethral sling (MUS) complications identified women with UDI-6 Q6 data before and after SSR. Q6 were compared pre- and postoperatively and against patient self-report of pain in women undergoing -SSR for pain (SSR-P) and in a control group when pain was not the primary indication for SSR (SSR-C). Women with missing pre-SSR or insufficient (<6 months) follow-up measures of pain were excluded. Three hypotheses were tested. (1) Correlation of Q6 scores with patients' self-reported pain pre- and post-SSR, (2) Higher pre-SSR Q6 scores in the SSR-P group than in the SSR-C group, and (3) Decrease in Q6 scores in the SSR-P group. RESULTS Between 2005 and 2017, 116 of 435 women referred to our institution met study criteria. Q6 scores were significantly (P <.0001) associated with self-reported pain with increasing likelihood of self-reporting pain as Q6 score increased. Mean pre-SSR Q6 scores in SSR-C (n = 42) was 1.0 ± 1.2 while mean pre-SSR Q6 scores in SSR-P (n = 74) was 2.3 ± 1.1 (P <.0001). Mean improvement in Q6 score after SSR was -0.19 ± 1.2 (P = 0.3) in SSR-C and -0.88 ± 1.4 (P <0.0001) in SSR-P. CONCLUSION In women undergoing SSR for MUS-related complications, Q6 scores were correlated to self-reported pain and responsive to surgical intervention for pain relief.
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Affiliation(s)
- Connie N Wang
- Department of Urology, Columbia University Irving Medical Center, New York, NY
| | - Alana L Christie
- Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX
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14
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Morton S, Wilczek Y, Harding C. Complications of synthetic mesh inserted for stress urinary incontinence. BJU Int 2020; 127:4-11. [PMID: 32981191 DOI: 10.1111/bju.15260] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/24/2020] [Accepted: 09/24/2020] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To provide an update on the literature regarding the management of complications secondary to synthetic mesh placed to treat stress urinary incontinence (SUI). METHODS We performed a systematic review of the literature using a multi-database structured search within OVID, the Medical Literature Analysis and Retrieval System Online (MEDLINE), the Excerpta Medica dataBASE (EMBASE) and Cochrane library databases; using the keywords: urology, incontinence, mesh and surgery. RESULTS Several million synthetic polypropylene meshes have been inserted into women worldwide to manage SUI. Unfortunately, a significant number of women have now reported life-changing complications. We found a paucity of studies, heterogeneity of cohorts, poor long-term follow-up, and lack of evidence on the effective management of mesh-related complications. CONCLUSIONS The contemporary evidence is low-level and often contradictory, which prevents robust recommendations regarding treatment. A prospective registry will be required to generate meaningful outcome data and help in the complex management of patients who have mesh-related complications.
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Affiliation(s)
- Simon Morton
- Department of Urology, Freeman Hospital, Newcastle upon Tyne, UK
| | - Yasmine Wilczek
- Department of Urology, Freeman Hospital, Newcastle upon Tyne, UK
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15
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Ambulo CP, Tasmim S, Wang S, Abdelrahman MK, Zimmern PE, Ware TH. Processing advances in liquid crystal elastomers provide a path to biomedical applications. JOURNAL OF APPLIED PHYSICS 2020; 128:140901. [PMID: 33060862 PMCID: PMC7546753 DOI: 10.1063/5.0021143] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 09/24/2020] [Indexed: 05/08/2023]
Abstract
Liquid crystal elastomers (LCEs) are a class of stimuli-responsive polymers that undergo reversible shape-change in response to environmental changes. The shape change of LCEs can be programmed during processing by orienting the liquid crystal phase prior to crosslinking. The suite of processing techniques that has been developed has resulted in a myriad of LCEs with different shape-changing behavior and mechanical properties. Aligning LCEs via mechanical straining yields large uniaxial actuators capable of a moderate force output. Magnetic fields are utilized to control the alignment within LCE microstructures. The generation of out-of-plane deformations such as bending, twisting, and coning is enabled by surface alignment techniques within thin films. 4D printing processes have emerged that enable the fabrication of centimeter-scale, 3D LCE structures with a complex alignment. The processing technique also determines, to a large extent, the potential applications of the LCE. For example, 4D printing enables the fabrication of LCE actuators capable of replicating the forces generated by human muscles. Employing surface alignment techniques, LCE films can be designed for use as coatings or as substrates for stretchable electronics. The growth of new processes and strategies opens and strengthens the path for LCEs to be applicable within biomedical device designs.
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Affiliation(s)
- Cedric P Ambulo
- Department of Bioengineering, The University of Texas at Dallas, Richardson, Texas 75080, USA
| | | | | | | | - Philippe E Zimmern
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas 75390, USA
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16
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Joint Position Statement on the Management of Mesh-Related Complications for the FPMRS Specialist. Female Pelvic Med Reconstr Surg 2020; 26:219-232. [DOI: 10.1097/spv.0000000000000853] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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17
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Joint position statement on the management of mesh-related complications for the FPMRS specialist. Int Urogynecol J 2020; 31:679-694. [DOI: 10.1007/s00192-020-04248-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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18
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Karmakar D, Dwyer PL, Nikpoor P. Mid‐urethral sling revision for mesh exposure–long‐term outcomes of two surgical techniques from a comparative clinical retrospective cohort study. BJOG 2020; 127:1027-1033. [DOI: 10.1111/1471-0528.16149] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2020] [Indexed: 10/25/2022]
Affiliation(s)
- D Karmakar
- Department of Urogynaecology Mercy Hospital for Women Heidelberg Victoria Australia
| | - PL Dwyer
- Department of Urogynaecology Mercy Hospital for Women Heidelberg Victoria Australia
| | - P Nikpoor
- Department of Urogynaecology Mercy Hospital for Women Heidelberg Victoria Australia
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Giarenis I, Anding R, Chermansky C, Greenwell T, Cardozo L, Harding C. Do we have adequate data to construct a valid algorithm for management of synthetic midurethral sling complications? ICI-RS 2019. Neurourol Urodyn 2020; 39 Suppl 3:S122-S131. [PMID: 32022954 DOI: 10.1002/nau.24299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 01/14/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND Synthetic midurethral sling (MUS) procedures, purported for the last two decades as the gold standard surgical treatment for stress urinary incontinence, have been in creasingly scrutinized in recent years with regard to the rate and severity of complications. METHODS During the International Consultation on Incontinence Research Society meeting held in Bristol, UK, in 2019, a multidisciplinary panel held a think tank and discussed the contemporary evidence pertaining to the classification, investigation, and treatment of MUS complications. RESULTS The current classification system of mesh-related complications was discussed, and shortcomings were identified. The lack of a standardized clinical pathway was noted, and the value of clinical investigations and surgical treatments was difficult to fully evaluate. The paucity of high-level evidence was a common factor in all discussions, and the difficulties with setting up relevant randomized-controlled trials were highlighted. CONCLUSIONS The outcome of the think-tank discussions is summarized with a set of recommendations designed to stimulate future research.
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Affiliation(s)
- Ilias Giarenis
- Department of Urogynaecology, Norfolk and Norwich Hospital, Norwich, UK
| | - Ralf Anding
- Department of Neurourology/Urology, Bonn and Neurological Rehabilitation Center "Godeshöhe" e.V., University Clinic, Friedrich Wilhelms University, Bonn, Germany
| | - Christopher Chermansky
- Department of Female Pelvic Medicine and Reconstructive Urology, UPMC Magee-Womens Hospital, Pittsburgh, Pennsylvania
| | - Tamsin Greenwell
- Department of Urology, University College London Hospital, London, UK
| | - Linda Cardozo
- Department of Urogynaecology, King's College Hospital, London, UK
| | - Christopher Harding
- Department of Urology, Freeman Hospital, Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, UK
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20
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FPMRS challenges on behalf of the Collaborative Research in Pelvic Surgery Consortium (CoRPS): managing complicated cases series 4: is taking out all of a mesh sling too extreme? Int Urogynecol J 2019; 31:221-225. [PMID: 31792592 DOI: 10.1007/s00192-019-04172-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 10/28/2019] [Indexed: 10/25/2022]
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21
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Blau EK, Adelstein SA, Amin KA, Durfy SJ, Lucioni A, Kobashi KC, Lee UJ. Tobacco use, immunosuppressive, chronic pain, and psychiatric conditions are prevalent in women with symptomatic mesh complications undergoing mesh removal surgery. Investig Clin Urol 2019; 61:S57-S63. [PMID: 32055755 PMCID: PMC7004833 DOI: 10.4111/icu.2020.61.s1.s57] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 10/13/2019] [Indexed: 11/18/2022] Open
Abstract
Purpose To identify demographic and clinical characteristics of patients with symptomatic pelvic floor mesh complications who underwent mesh removal at our academic medical center. The secondary goal was to determine patient-reported outcomes after mesh removal. Materials and Methods We conducted a retrospective review of consecutive patients from 2011-2016 undergoing removal of mesh graft for treatment of symptomatic mesh-related complications. Patient demographics, comorbidities, symptoms, and mesh factors were evaluated. Outcomes after explant were determined by the Patient Global Impression of Improvement and a Likert satisfaction scale. Results One hundred fifty-six symptomatic patients underwent complete or partial pelvic floor mesh removal during the study period. Mid-urethral slings comprised 86% of explanted mesh grafts. Mesh exposure or erosion was identified in 72% of patients. Eighty-one percent of patients presented with pain, and 35% reported pain in the absence of exposure or erosion. Pre-operative comorbidities included psychiatric disease (54.5%), chronic pain (34.0%), irritable bowel syndrome (20.5%) and fibromyalgia (9.6%). Forty-three percent of patients reported current or past tobacco use. At mean follow-up of 14 months, 68% of responding patients reported improvement on the Patient Global Impression of Improvement after surgery. Conclusions This research identified tobacco use, and psychiatric, immunosuppressive, and chronic pain conditions as prevalent in this cohort of patients undergoing mesh removal. Surgical removal can improve presenting symptoms, including for patients with pain in the absence of other indications.
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Affiliation(s)
- Elliot K Blau
- Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, WA, USA
| | - Sarah A Adelstein
- Department of Urology, Rush University Medical Center, Chicago, IL, USA
| | - Katherine A Amin
- Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, WA, USA
| | - Sharon J Durfy
- Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, WA, USA
| | - Alvaro Lucioni
- Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, WA, USA
| | - Kathleen C Kobashi
- Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, WA, USA
| | - Una J Lee
- Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, WA, USA
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22
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Multidimensional outcomes of suburethral synthetic midurethral sling removal. World J Urol 2019; 38:2005-2012. [PMID: 31696257 DOI: 10.1007/s00345-019-02987-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 10/13/2019] [Indexed: 10/25/2022] Open
Abstract
PURPOSE To report multidimensional outcomes encompassing pain, dyspareunia, and recurrent urinary tract infections (UTIs), following suburethral sling removal (SSR) of synthetic midurethral slings (MUS) placed for female stress urinary incontinence. METHODS We reviewed a prospectively maintained, IRB-approved database of women undergoing SSR at our institution. Demographic data, type of sling, and symptoms along with Urogenital Distress Inventory-Short Form (UDI-6) scores both before and after SSR were analyzed. Success was defined using several modalities including patient-reported symptoms (ideal outcome) and UDI-6 questionnaire. RESULTS From 3/2006-2/2017, 443 women underwent SSR of which 230 met study criteria with median overall follow-up of 23 months (mean 30 months). 180/230 (78%) patients reported 3 or more symptoms at presentation. Median most recent post-SSR total UDI-6 score was 38 vs. 50 at baseline (p < 0.0001). By UDI-6, 53% of patients achieved success post-SSR. An ideal outcome was attained in 22/230 (10%) patients. A modified outcome allowing for one minimally invasive anti-incontinence procedure and excluding sexual activity classified 112/230 (49%) patients as successes. CONCLUSIONS While patients with MUS present with multiple symptoms, following SSR, there is sustained improvement in multiple symptom domains, including pain and urinary incontinence. Allowing for minimally invasive anti-incontinence procedures (not inclusive of subsequent suburethral sling), the rate of success was 49%, which was comparable to that derived from UDI-6 scores (53%).
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Carter P, Fou L, Whiter F, Delgado Nunes V, Hasler E, Austin C, Macbeth F, Ward K, Kearney R. Management of mesh complications following surgery for stress urinary incontinence or pelvic organ prolapse: a systematic review. BJOG 2019; 127:28-35. [DOI: 10.1111/1471-0528.15958] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2019] [Indexed: 11/27/2022]
Affiliation(s)
- P Carter
- Research Department of Clinical Educational & Health Psychology University College London London UK
| | - L Fou
- National Guideline Alliance Royal College of Obstetricians and Gynaecologists London UK
| | - F Whiter
- National Guideline Alliance Royal College of Obstetricians and Gynaecologists London UK
| | - V Delgado Nunes
- National Guideline Alliance Royal College of Obstetricians and Gynaecologists London UK
| | - E Hasler
- National Guideline Alliance Royal College of Obstetricians and Gynaecologists London UK
| | - C Austin
- National Institute for Health and Care Excellence Manchester UK
| | - F Macbeth
- Centre for Trials Research Cardiff University Cardiff UK
| | - K Ward
- The Warrell Unit St Mary's Hospital Manchester UK
- Manchester Academic Health Science Centre University Hospitals NHS Foundation Trust Manchester UK
| | - R Kearney
- The Warrell Unit St Mary's Hospital Manchester UK
- Manchester Academic Health Science Centre University Hospitals NHS Foundation Trust Manchester UK
- Faculty of Medical Human Sciences University Institute of Human Development University of Manchester Manchester UK
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24
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Sobota R, Thomas D, Demetres M, Cadestin V, Mao T, Asfaw T, Chughtai B. The Management and Efficacy of Surgical Techniques Used for Erosive Mesh in the Urethra and Bladder: A Systematic Review. Urology 2019; 134:2-23. [PMID: 31415778 DOI: 10.1016/j.urology.2019.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 07/24/2019] [Accepted: 08/05/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND This study reports the re-operation and symptom resolution rates of different techniques used in surgical excision of genitourinary mesh erosions. METHODS A comprehensive systematic review was completed after searching electronic databases for studies involving outcomes of mesh erosion in humans that were managed surgically using a transvaginal, cystoscopic, or abdominal approach. Surgical outcomes were reported in percentages, ranges, and simple pooling to generate trends in management techniques. RESULTS There were 177 cases that met our inclusion criteria. Forty-one patients underwent cystoscopic removal of eroded urethral mesh while 40 cases underwent transvaginal removal of urethral mesh. CONCLUSIONS For mesh eroded into the urethra, a transvaginal vs. cystoscopic approach showed a trend toward resolution of symptoms and fewer interventions. For mesh eroded into the bladder, abdominal and cystoscopic approaches had similar symptom resolution, but abdominal approach required fewer interventions.
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Affiliation(s)
- Rosanna Sobota
- Department of Urology, Weill Cornell Medical College/New York-Presbyterian, New York, NY
| | - Dominique Thomas
- Department of Urology, Weill Cornell Medical College/New York-Presbyterian, New York, NY
| | - Michelle Demetres
- Samuel J. Wood Library and C.V. Starr Biomedical Information Center, New York, NY
| | - Vickie Cadestin
- Department Obstetrics and Gynecology, Weill Cornell Medical College/New York-Presbyterian, New York, NY
| | - Tsung Mao
- Department Obstetrics and Gynecology, Weill Cornell Medical College/New York-Presbyterian, New York, NY
| | - Tirsit Asfaw
- Department Obstetrics and Gynecology, Weill Cornell Medical College/New York-Presbyterian, New York, NY
| | - Bilal Chughtai
- Department of Urology, Weill Cornell Medical College/New York-Presbyterian, New York, NY; Department Obstetrics and Gynecology, Weill Cornell Medical College/New York-Presbyterian, New York, NY.
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25
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Lee D, Zimmern PE. An update on research and outcomes in surgical management of vaginal mesh complications. Expert Rev Med Devices 2019; 16:569-580. [DOI: 10.1080/17434440.2019.1626230] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Dominic Lee
- Department of Urology, St. George Hospital, Kogarah, New South Wales, Australia
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26
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Sihra N, Kujawa M, Solomon E, Harding C, Sahai A, Malde S. Female stress urinary incontinence MDT. JOURNAL OF CLINICAL UROLOGY 2019. [DOI: 10.1177/2051415818821548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The management of female stress urinary incontinence (SUI) has come under scrutiny in recent years following growing reports of mesh-related complications. Patients require thorough evaluation and management as part of a multidisciplinary team, and extensive counselling about the surgical treatment options is imperative. There is no clear consensus on the optimal management of the complex group of patients with mesh-related complications or recurrent SUI. We present two cases of female SUI to highlight the key factors to be considered when managing these patients. Level of evidence: Level 5.
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Affiliation(s)
- Néha Sihra
- Department of Urology, St George’s Hospital, London, UK
| | - Magda Kujawa
- Department of Urology, Stockport NHS Foundation Trust, Stepping Hill Hospital, UK
| | - Eskinder Solomon
- Department of Urology, Guy’s and St Thomas’ NHS Foundation Trust, Guy’s Hospital, UK
| | | | - Arun Sahai
- Department of Urology, Guy’s and St Thomas’ NHS Foundation Trust, Guy’s Hospital, UK
| | - Sachin Malde
- Department of Urology, Guy’s and St Thomas’ NHS Foundation Trust, Guy’s Hospital, UK
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27
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Management of Mesh-Related Pelvic Inflammation. CURRENT BLADDER DYSFUNCTION REPORTS 2018. [DOI: 10.1007/s11884-018-0489-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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28
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Ismail S, Chartier-Kastler E, Reus C, Cohen J, Seisen T, Phé V. Functional outcomes of synthetic tape and mesh revision surgeries: a monocentric experience. Int Urogynecol J 2018; 30:805-813. [DOI: 10.1007/s00192-018-3727-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 07/17/2018] [Indexed: 10/28/2022]
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29
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Jong K, Popat S, Christie A, Zimmern PE. Is pain relief after vaginal mesh and/or sling removal durable long term? Int Urogynecol J 2018; 29:859-864. [PMID: 28695345 DOI: 10.1007/s00192-017-3413-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 06/22/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION AND HYPOTHESIS This study was to review our experience of pain relief durability in women who experienced initial pain resolution after vaginal mesh and/or sling removal (VMSR). METHODS A retrospective chart review of consecutive, nonneurogenic women who underwent VMSR for pain and reported persistent pain relief at the 6-month postoperative follow-up visit were assessed. Pre- and postoperative data collected were self-reported chief complaints, physical examination, other medical conditions associated with chronic pain, use of pain medications, Urogenital Distress Inventory-6 (in which question 6 specifically addresses pain), and the Numerical Pain Rating Scale (NPRS). Success was defined by continued resolution of pain assessed by score of 0 on NPRS (0 none to 10 terrible), (0-1 on the Urogenital Distress Inventory-6 (UDI-6) question 6, subjective report of pain-free status, and/or no chronic use of pain medications other than those prescribed for non-mesh-related pain. RESULTS Between 2006 and 2015, 125 of 356 women met study criteria. Mean follow-up after VMSR was 3.5 (range 0.5-10) years. Among 25 women who did not meet success criteria by questionnaire answers or subjective report, 21 had causes unrelated to their original mesh/sling placement and were pain free after they were addressed. Four women experienced delayed mesh-related pain return at 28, 46, 47, and 54 months, respectively; two required mesh removal surgery. Involvement in lawsuits and chronic pain-related medical conditions did not affect the durability of pain relief. CONCLUSIONS At a mean follow-up of 3.5 years, the original pain relief noted after VMSR was durably maintained.
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Affiliation(s)
- Karen Jong
- University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9110, USA
| | - Shreeya Popat
- University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9110, USA
| | - Alana Christie
- University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9110, USA
| | - Philippe E Zimmern
- University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9110, USA.
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Shakir NA, Wang C, Singla N, Alhalabi F, Christie A, Lemack GE, Zimmern PE. Challenges of Multidimensional Outcome Reporting after Suburethral Mid Urethral Sling Removal. J Urol 2018; 199:1577-1583. [PMID: 29307687 DOI: 10.1016/j.juro.2017.12.059] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE We sought to determine the types and frequency of presenting symptoms in women undergoing suburethral mid urethral sling removal to improve outcome reporting after removal. MATERIALS AND METHODS Following institutional review board approval women who underwent suburethral mid urethral sling removal of 1 mid urethral sling were evaluated for their presenting symptoms and correlation with the UDI-6 (Urogenital Distress Inventory-Short Form) questionnaire. Demographic data were recorded. Patient reported presenting symptoms were categorized into 5 domains, including storage symptoms, voiding symptoms, pain, recurrent urinary tract infections or urinary incontinence. The UDI-6 was reviewed preoperatively and 6 to 12 months postoperatively. We also calculated an ideal outcome, defined as resolution of incontinence, pain, resumption of sexual activity and no need for further anti-incontinence procedures. RESULTS A total of 230 women from 2006 to 2017 met study inclusion criteria, including 116 who completed the UDI-6 postoperatively. Of the women 80% had 3 or more presenting symptoms with pain as the most common symptom. The most common combination of symptoms was all 5 domains, which was noted in 46 of the 230 women (20%). An increasing number of symptoms correlated with the total preoperative UDI-6 score. Symptom domains were associated with the corresponding UDI-6 subdomain questions. Domains not covered by the UDI-6, ie recurrent urinary tract infections and dyspareunia, accounted for 27% of reported symptoms. Due to limited data on sexual activity an ideal outcome was reached in 10% of patients but this rate was 40% after sexual activity information was excluded. CONCLUSIONS In this series the presenting symptoms were manifold in women undergoing suburethral mid urethral sling removal. The UDI-6 questionnaire correlated with many of these complaints. It may be used in outcome analysis in conjunction with self-reported symptoms.
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Affiliation(s)
- Nabeel A Shakir
- Department of Urology and Division of Biostatistics, Simmons Comprehensive Cancer Center (AC), University of Texas Southwestern Medical Center, Dallas, Texas
| | - Connie Wang
- Department of Urology and Division of Biostatistics, Simmons Comprehensive Cancer Center (AC), University of Texas Southwestern Medical Center, Dallas, Texas
| | - Nirmish Singla
- Department of Urology and Division of Biostatistics, Simmons Comprehensive Cancer Center (AC), University of Texas Southwestern Medical Center, Dallas, Texas
| | - Feras Alhalabi
- Department of Urology and Division of Biostatistics, Simmons Comprehensive Cancer Center (AC), University of Texas Southwestern Medical Center, Dallas, Texas
| | - Alana Christie
- Department of Urology and Division of Biostatistics, Simmons Comprehensive Cancer Center (AC), University of Texas Southwestern Medical Center, Dallas, Texas
| | - Gary E Lemack
- Department of Urology and Division of Biostatistics, Simmons Comprehensive Cancer Center (AC), University of Texas Southwestern Medical Center, Dallas, Texas
| | - Philippe E Zimmern
- Department of Urology and Division of Biostatistics, Simmons Comprehensive Cancer Center (AC), University of Texas Southwestern Medical Center, Dallas, Texas.
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Singla N, Aggarwal H, Foster J, Alhalabi F, Lemack GE, Zimmern PE. Management of Urinary Incontinence Following Suburethral Sling Removal. J Urol 2017; 198:644-649. [DOI: 10.1016/j.juro.2017.02.3341] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Nirmish Singla
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Himanshu Aggarwal
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jeannine Foster
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Feras Alhalabi
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Gary E. Lemack
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Philippe E. Zimmern
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
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Lee D, Bacsu C, Dillon B, Zimmern PE. Complications Following the Insertion of Two Synthetic Mid-urethral Slings and Subsequent Removal. Low Urin Tract Symptoms 2017; 10:259-265. [PMID: 28657139 DOI: 10.1111/luts.12175] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Revised: 02/12/2017] [Accepted: 02/27/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine outcomes after removal of two synthetic mid-urethral slings (MUS) at a tertiary care center. METHODS Following IRB approval, a retrospective chart review of non-neurogenic, symptomatic women requiring re-operation after ≥2 MUS was performed. Data reviewed by a third party included: demographics, prior anti-incontinence surgery, complications, pelvic/urinary symptoms, subsequent investigations, surgical repair and outcomes (including UDI-6/IIQ-7 questionnaires) at a minimum 6 months follow-up. Cure was defined as being continent, no dyspareunia, and no additional surgical therapy. RESULTS Between 2007 and 2014, 21 women met the inclusion criteria. Mean age was 57 years (range: 40-82) and mean follow-up was 30.2 months (range: 6-78). The majority of patients presented with one or more symptoms of voiding dysfunction (95%), urinary incontinence (86%), irritative voiding symptoms (62%), dyspareunia (57%), recurrent urinary tract infections (UTIs) (29%), vaginal extrusion (20%) and erosion involving the urinary tract (5%). Patients had a mean of 2 prior anti-incontinence procedures (range 2-3). Over two-thirds had a combination of retropubic and transobturator MUS. Mean number of pre-operative investigations was 3.5 (1-6) including voiding cystourethrogram, cystoscopy and urodynamics. Two patients had complete remission, 14 partial remission, and five failed. Mean postoperative total UDI-6 and IIQ-7 scores at last clinic visit were 10 (range: 0-16/SD 4.1) and 11 (range: 0-28/SD 10.3), respectively. CONCLUSION The management of women with suboptimal outcomes following two synthetic MUS from transvaginal excision results in modest symptomatic improvement but low permanent complete remission and frequent need for additional therapies.
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Affiliation(s)
- Dominic Lee
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Chasta Bacsu
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Benjamin Dillon
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Philippe E Zimmern
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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How to Deal with Pain Following a Vaginal Mesh Insertion. Eur Urol Focus 2016; 2:268-271. [DOI: 10.1016/j.euf.2016.04.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Revised: 03/21/2016] [Accepted: 04/25/2016] [Indexed: 11/23/2022]
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Re: Management of Complications of Mesh Surgery. J Urol 2016; 195:1539-1543. [PMID: 27186749 DOI: 10.1016/j.juro.2016.02.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2016] [Indexed: 11/21/2022]
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The Role of Chronic Mesh Infection in Delayed-Onset Vaginal Mesh Complications or Recurrent Urinary Tract Infections. Female Pelvic Med Reconstr Surg 2016; 22:166-71. [DOI: 10.1097/spv.0000000000000246] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Blaivas JG, Purohit RS, Benedon MS, Mekel G, Stern M, Billah M, Olugbade K, Bendavid R, Iakovlev V. Safety considerations for synthetic sling surgery. Nat Rev Urol 2015; 12:481-509. [DOI: 10.1038/nrurol.2015.183] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Coskun B, Lavelle RS, Alhalabi F, Lemack G, Zimmern PE. Urodynamics for incontinence after midurethral sling removal. Neurourol Urodyn 2015. [DOI: 10.1002/nau.22831] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | | | | | - Gary Lemack
- UT Southwestern Medical Center; Dallas Texas
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Rogowski A, Bienkowski P, Tarwacki D, Szafarowska M, Samochowiec J, Sienkiewicz-Jarosz H, Jerzak M, Baranowski W. Retrospective comparison between the Prolift and Elevate anterior vaginal mesh procedures: 18-month clinical outcome. Int Urogynecol J 2015; 26:1815-20. [DOI: 10.1007/s00192-015-2772-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 06/19/2015] [Indexed: 01/19/2023]
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Mousa NA, Abou-Taleb HA, Orabi H. Stem cell applications for pathologies of the urinary bladder. World J Stem Cells 2015; 7:815-822. [PMID: 26131312 PMCID: PMC4478628 DOI: 10.4252/wjsc.v7.i5.815] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Revised: 02/05/2015] [Accepted: 04/07/2015] [Indexed: 02/06/2023] Open
Abstract
New stem cell based therapies are undergoing intense research and are widely investigated in clinical fields including the urinary system. The urinary bladder performs critical complex functions that rely on its highly coordinated anatomical composition and multiplex of regulatory mechanisms. Bladder pathologies resulting in severe dysfunction are common clinical encounter and often cause significant impairment of patient’s quality of life. Current surgical and medical interventions to correct urinary dysfunction or to replace an absent or defective bladder are sub-optimal and are associated with notable complications. As a result, stem cell based therapies for the urinary bladder are hoped to offer new venues that could make up for limitations of existing therapies. In this article, we review research efforts that describe the use of different types of stem cells in bladder reconstruction, urinary incontinence and retention disorders. In particular, stress urinary incontinence has been a popular target for stem cell based therapies in reported clinical trials. Furthermore, we discuss the relevance of the cancer stem cell hypothesis to the development of bladder cancer. A key subject that should not be overlooked is the safety and quality of stem cell based therapies introduced to human subjects either in a research or a clinical context.
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Rawlings T, Lavelle RS, Coskun B, Alhalabi F, Zimmern PE. Prolapse Recurrence after Transvaginal Mesh Removal. J Urol 2015; 194:1342-7. [PMID: 26119669 DOI: 10.1016/j.juro.2015.06.080] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE We determined the rate of pelvic organ prolapse recurrence after transvaginal mesh removal. MATERIALS AND METHODS Following institutional review board approval a longitudinally collected database of women undergoing transvaginal mesh removal for complications after transvaginal mesh placement with at least 1 year minimum followup was queried for pelvic organ prolapse recurrence. Recurrent prolapse was defined as greater than stage 1 on examination or the need for reoperation at the site of transvaginal mesh removal. Outcome measures were based on POP-Q (Pelvic Organ Prolapse Quantification System) at the last visit. Patients were grouped into 3 groups, including group 1--recurrent prolapse in the same compartment as transvaginal mesh removal, 2--persistent prolapse and 3--prolapse in a compartment different than transvaginal mesh removal. RESULTS Of 73 women 52 met study inclusion criteria from 2007 to 2013, including 73% who presented with multiple indications for transvaginal mesh removal. The mean interval between insertion and removal was 45 months (range 10 to 165). Overall mean followup after transvaginal mesh removal was 30 months (range 12 to 84). In group 1 (recurrent prolapse) the rate was 15% (6 of 40 patients). Four women underwent surgery for recurrent prolapse at a mean 7 of months (range 5 to 10). Two patients elected observation. The rate of persistent prolapse (group 2) was 23% (12 of 52 patients). Three women underwent prolapse reoperation at a mean of 10 months (range 8 to 12). In group 3 (de novo/different compartment prolapse) the rate was 6% (3 of 52 patients). One woman underwent surgical repair at 52 months. CONCLUSIONS At a mean 2.5-year followup 62% of patients (32 of 52) did not have recurrent or persistent prolapse after transvaginal mesh removal and 85% (44 of 52) did not undergo any further procedure for prolapse. Specifically for pelvic organ prolapse in the same compartment as transvaginal mesh removal 12% of patients had recurrence, of whom 8% underwent prolapse repair.
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Affiliation(s)
- Tanner Rawlings
- University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - Burhan Coskun
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Feras Alhalabi
- University of Texas Southwestern Medical Center, Dallas, Texas
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Abstract
Female urinary incontinence represents a medical and social problem with huge impact regarding both patient's quality of life and social costs. The diagnosis is important for therapeutic choice and should consider some factors: the degree of urethral mobility, urodynamics parameters, patient's will and expectations, information about surgical complications and risks. Nowadays suburethral sling evolution and bulking therapy for selected cases consent to perform miniinvasive surgery; the most relevant problem concerns the management of postoperative complications: in this sense autologous slings are used after urethrolisis. In most difficult cases, it is possible to consider artificial sphincter as the best option.
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Steers WD. This Month in Adult Urology. J Urol 2014. [DOI: 10.1016/j.juro.2014.06.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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