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Even L, Tibi B, Bentellis I, Treacy PJ, Berrogain N, Bosset PO, Campagne-Loiseau S, Cardot V, Charles T, Deffieux X, Donon L, Girard F, Hermieu JF, Hurel S, Klap J, Meyer F, Peyrat L, Thuillier C, Vidart A, Wagner L, Cornu JN. [Complications of mid-urethral sling - A review from the Committee for Female Urology and Pelviperineology for the French Association of Urology]. Prog Urol 2021; 31:1141-1166. [PMID: 34794867 DOI: 10.1016/j.purol.2021.09.007] [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: 07/19/2021] [Revised: 09/22/2021] [Accepted: 09/23/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Placement of a mid-urethral sling is the gold standard in the surgical management of stress urinary incontinence in women in France. The cure rate of this material is no longer to be demonstrated, but the per- and post-operative complications are currently the subject of a growing controversy not only in Europe but also across the Channel and across the Atlantic, having led to the modification of operative indications. In France, recommendations are also evolving with a stricter framework for indications for surgery by multidisciplinary consultation meeting and an obligation for postoperative follow-up in the short and long term. OBJECTIVES In this context, CUROPF realized a review of the literature bringing together the available scientific evidence concerning the occurrence of per- and post-operative complications relating to the installation of mid urethral sling. The bibliographic search was carried out using the Medline database and 123 articles were selected. RESULTS Analysis of the data highlights various complications, depending on the implanted material, the patient and the indication for surgery. The retro-pubic mid urethral sling provides more bladder erosion during surgery (up to 14%), more suprapubic pain (up to 4%) and more acute urinary retention (up to 19,7%) and postoperative dysuria (up to 26%). The trans obturator mid-urethral sling is responsible for more vaginal erosion during the operation (up to 10,9%), more lower limb pain of neurological origin (up to 26,7%). The risk of developing over active bladder is similar in both procedures (up to 33%). But these risks of complications must be balanced by the strong impact of urinary incontinence surgery on the overall quality of life of these women. CONCLUSION Thus, surgical failure and long term complications exist but should not limit the surgical management of stress urinary incontinence with mid urethral tape. Women should be treated with individualized decision-making process and long-term follow -up is necessary.
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Affiliation(s)
- L Even
- Cabinet d'urologie, espace santé 3 83500 La Seyne sur Mer, clinique du Cap d'Or, 83500 La Seyne sur mer, Polyclinique Les Fleurs, 83190 Ollioules, France
| | - B Tibi
- Service d'urologie, université de Nice-Sophia Antipolis, hôpital Pasteur 2, CHU de Nice, 06000 Nice, France
| | - I Bentellis
- Service d'urologie, université de Nice-Sophia Antipolis, hôpital Pasteur 2, CHU de Nice, 06000 Nice, France
| | - P J Treacy
- Service d'urologie, université de Nice-Sophia Antipolis, hôpital Pasteur 2, CHU de Nice, 06000 Nice, France
| | - N Berrogain
- Clinique Ambroise-Paré, 31100 Toulouse, France
| | - P O Bosset
- Service d'urologie, hôpital Foch, 40, rue Worth, 92150 Suresnes, France
| | - S Campagne-Loiseau
- Service de gynécologie-obstétrique, CHU Estaing, Clermont-Ferrand, France
| | - V Cardot
- Clinique de Meudon-Clamart, 3, avenue de Villacoublay, 92360 Meudon, France
| | - T Charles
- Service d'urologie, CHU La Miletrie, 86000 Poitiers, France
| | - X Deffieux
- Service de gynécologie-obstétrique, hôpital Antoine-Béclère (AP-HP), 92140 Clamart, France
| | - L Donon
- Clinique de la Côte Basque, 64100 Bayonne, France
| | - F Girard
- Service d'urologie, clinique Oudinot Fondation Cognac-Jay, 2, rue Rousselet, 75007 Paris, France
| | - J-F Hermieu
- Service d'urologie, hôpital Bichat, AP-HP, Paris, France
| | - S Hurel
- Service d'urologie, hôpital européen Georges-Pompidou, AP-HP, Paris, France
| | - J Klap
- Service d'urologie, hôpital Privé Claude Galien, 91480 Quincy-sous-Sénart, France
| | - F Meyer
- Service d'urologie, hôpital Saint-Louis, AP-HP, Paris, France
| | - L Peyrat
- Service d'urologie, clinique Turin, 75008 Paris, France
| | - C Thuillier
- Service d'urologie, CHU Grenoble-Alpes, 38000 Grenoble, France
| | - A Vidart
- Service d'urologie, hôpital Foch, 40, rue Worth, 92150 Suresnes, France
| | - L Wagner
- Service d'urologie, CHU de Nîmes, place du Pr-Robert-Debré, 30029 Nîmes cedex 9, France
| | - J N Cornu
- Service d'urologie, université de Rouen, hôpital Charles-Nicolle, 1, rue de Germont, 76000 Rouen, France.
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Kerbaj J, Aubry C, Prost C, Brouqui P. Thigh abscess and necrotizing fasciitis following an inside-out transobturator tape intervention: a case report. J Med Case Rep 2016; 10:146. [PMID: 27256334 PMCID: PMC4890333 DOI: 10.1186/s13256-016-0942-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 05/10/2016] [Indexed: 01/04/2023] Open
Abstract
Background Tension-free vaginal transobturator tapes are used worldwide in the treatment of urinary incontinence in women. Very few severe complications have been described following this procedure, with no standard treatment yet established. Case presentation We present the case of a 36-year-old French white woman with no remarkable medical history, presenting with an abscess and necrotizing fasciitis 48 hours after an inside-out tension-free transobturator procedure. Samples were collected by guided puncture from the abscess, retrieving Staphylococcus aureus and Citrobacter koseri. Conclusions Severe complications following this procedure are rare, although it can have the potential for significant morbidity and even mortality, which is worth highlighting. We recommend early surgical treatment in combination with broad-spectrum antibiotics and coverage for Staphylococcus aureus, which may be a causative agent. Electronic supplementary material The online version of this article (doi:10.1186/s13256-016-0942-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jad Kerbaj
- Maladies Infectieuses et Tropicales, CHU Nord, AP-HM, Pôle des Maladies Infectieuses et Tropicales, Marseille, France.,Aix Marseille Université, URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, 13005, Marseille, France
| | - Camille Aubry
- Maladies Infectieuses et Tropicales, CHU Nord, AP-HM, Pôle des Maladies Infectieuses et Tropicales, Marseille, France.,Aix Marseille Université, URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, 13005, Marseille, France.,Institut Hospitalo-Universitaire Méditerranée Infection, 13005, Marseille, France
| | - Caroline Prost
- Service d'imagerie Médicale, CHU Nord, AP-HM, Marseille, France
| | - Philippe Brouqui
- Maladies Infectieuses et Tropicales, CHU Nord, AP-HM, Pôle des Maladies Infectieuses et Tropicales, Marseille, France. .,Aix Marseille Université, URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, 13005, Marseille, France. .,Institut Hospitalo-Universitaire Méditerranée Infection, 13005, Marseille, France.
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King AB, Tenggardjaja C, Goldman HB. Prospective Evaluation of the Effect of Thigh Dissection for Removal of Transobturator Mid Urethral Slings on Refractory Thigh Pain. J Urol 2016; 196:1207-12. [PMID: 27049875 DOI: 10.1016/j.juro.2016.03.153] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE Transobturator slings have higher rates of de novo neurologic symptoms than retropubic slings, most commonly related to the thigh. Cases refractory to conservative management may require removal of the thigh portion of the sling. In this series we prospectively examine the effect of thigh dissection with mesh removal on refractory thigh pain. MATERIALS AND METHODS All thigh dissections for refractory neurologic symptoms after transobturator sling placement were followed prospectively from October 2012 to October 2015. Patients were assessed preoperatively, with a pain score using a visual analog scale, and postoperatively with a global response assessment. RESULTS A total of 12 thigh dissections were performed from October 2012 to October 2015 in 8 patients. Mean (±SD) time from original mesh placement to presentation was 2.7 (±1.5) years. Average preoperative pain score was 7.9 (±1.7) out of 10, with pain in the thigh in all patients. Seven cases involved unilateral thigh dissection and 1 had concomitant bilateral thigh dissection. Five patients underwent concurrent transvaginal excision. On postoperative evaluation the average global response rating was 1.6, with 1 defined as very much better and 2 defined as much better. Of the 8 patients 3 went on to have the contralateral side done with an average global response rating of 1.3 (±0.6). One patient underwent further treatment for stress urinary incontinence with placement of a retropubic mid urethral sling. CONCLUSIONS Our prospective series supports the use of thigh dissection in patients with refractory neurologic symptoms after transobturator sling placement. The procedure can be performed safely with positive outcomes for the patient.
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Affiliation(s)
- A B King
- Center for Female Pelvic Medicine and Reconstructive Surgery, Glickman Urological and Kidney Institute, Lerner College of Medicine, Cleveland Clinic, Cleveland, Ohio.
| | - C Tenggardjaja
- Center for Female Pelvic Medicine and Reconstructive Surgery, Glickman Urological and Kidney Institute, Lerner College of Medicine, Cleveland Clinic, Cleveland, Ohio
| | - H B Goldman
- Center for Female Pelvic Medicine and Reconstructive Surgery, Glickman Urological and Kidney Institute, Lerner College of Medicine, Cleveland Clinic, Cleveland, Ohio
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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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Serratia marcescens thigh infection after transobturator sling without associated mesh exposure. Female Pelvic Med Reconstr Surg 2014; 21:e19-20. [PMID: 25185597 DOI: 10.1097/spv.0000000000000118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Soft tissue complications of the thigh occur after transobturator slings and are reported to uniformly accompany mesh exposure. Most commonly identified microorganisms cultured from such soft tissue infections include Bacteroides and Streptococcus species. This is the first reported case of Serratia marcescens leading to thigh cellulitis after a transobturator sling and the complication occurred in the absence of exposed mesh. CASE A 54-year-old presented 7 days after a transobturator sling with right thigh cellulitis and sepsis in the absence of mesh exposure. She underwent explantation of the sling and incision and drainage of the groin incision. Cultures grew S. marcescens. DISCUSSION Soft tissue infections of the thigh after transobturator tape are rare, but commonly associated with exposed mesh. Mesh exposure does not lead to thigh complications uniformly. The fact that this patient had no exposed mesh poses several questions about the pathogenesis of soft tissue infections of the thigh after transobturator slings.
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Interobserver variability when employing the IUGA/ICS classification system for complications related to prostheses and grafts in female pelvic floor surgery. Int Urogynecol J 2013; 24:1671-8. [DOI: 10.1007/s00192-013-2078-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Accepted: 02/23/2013] [Indexed: 10/27/2022]
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Rajendra M, Han HC, Lee LC, Tseng LAA, Wong HF. Retrospective study on tension-free vaginal tape obturator (TVT-O). Int Urogynecol J 2011; 23:327-34. [PMID: 21892684 DOI: 10.1007/s00192-011-1552-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2011] [Accepted: 08/10/2011] [Indexed: 10/17/2022]
Abstract
INTRODUCTION AND HYPOTHESIS We aim to report the 3-year outcome and complications of the tension-free vaginal tape obturator (TVT-O) in treating female stress urinary incontinence (SUI). METHODS Retrospective analysis for complications and outcome of surgery was performed in 419 women undergoing the TVT-O from 2004 to 2006. RESULTS Three patients (0.8%) with an isolated TVT-O had a blood loss of more than 200 ml. Two patients (0.5%) had bladder perforation. Out of 11 readmitted patients (2.6%), 10 were due to voiding difficulty. Six patients (1.4%) required tape loosening or division. Persistent pain occurred in 3.6% and erosion in 2.4% of patients. One hundred eighty-five patients (44.2%) came for follow-up at 3 years. The actual subjective and objective success rates were 89.7% and 99.9% at 3 years follow-up, respectively. With imputation, the 3-year subjective and objective success rates were 86.9% and 97.4%, respectively. CONCLUSIONS The TVT-O is effective in treating female SUI with minimal complications.
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Affiliation(s)
- Malathi Rajendra
- Obstetrics and Gynaecology Department, Selayang Hospital, Lebuhraya Kepong-Selayang, Batu Caves, 68100 Selangor, Malaysia.
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An Open-Label, Noncomparative, Multicenter Study to Evaluate Efficacy and Safety of NASHA/Dx Gel as a Bulking Agent for the Treatment of Fecal Incontinence. Gastroenterol Res Pract 2010; 2010:467136. [PMID: 21234379 PMCID: PMC3017894 DOI: 10.1155/2010/467136] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2010] [Revised: 10/01/2010] [Accepted: 11/04/2010] [Indexed: 12/17/2022] Open
Abstract
Fecal incontinence (FI) is the involuntary loss of rectal contents through the anal canal. Reports of its prevalence vary from 1–21%. Studies, have demonstrated a positive effect on FI symptoms with injectable bulking agents. This study evaluated the safety and efficacy of NASHA/Dx gel in the treatment of FI. One hundred fifteen eligible patients suffering from FI received 4 injections of 1 mL NASHA/Dx gel. Primary efficacy was based on data from 86 patients that completed the study. This study demonstrated a ≥50% reduction from baseline in the number of FI episodes in 57.1% of patients at 6 months, and 64.0% at 12 months. Significant improvements (P < .001) were also noted in total number of both solid and loose FI episodes, FI free days, CCFIS, and FIQL scores in all 4 domains. The majority of the treatment related AEs (94.9%) were mild or moderate intensity, and (98.7%) of AEs resolved spontaneously, or following treatment, without sequelae. Results of this study indicate NASHA/Dx gel was efficacious in the treatment of FI. Treatment effect was significant both in reduction of number of FI episodes and disease specific quality of life at 6 months and lasted up to 12 months after treatment.
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Acute and serious myositis with abscess in thigh muscle after transobturator tape implantation. Int Neurourol J 2010; 14:182-5. [PMID: 21179337 DOI: 10.5213/inj.2010.14.3.182] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2010] [Accepted: 10/25/2010] [Indexed: 11/08/2022] Open
Abstract
The complications of transobturator tape (TOT) were known as lower urinary tract injury, postoperative urinary retention, urge incontinence, vaginal erosion, and etc. A 63-year-old woman presented with new onset of severe pain, heating, and swelling of the left thigh and perineum. She had undergone TOT implantation for stress urinary incontinence (SUI) 4 days previously in an outside clinic. Painful left thigh swelling and skin erythema were noted on the physical examination. A computed tomography (CT) scan showed multiple, large left medial thigh and obturator abscesses. Removal of the implanted tape and abscess drainage were performed immediately and two additional operations were needed for proper abscess drainage. We believe this case to be one of the most serious complications to occur since the introduction of the TOT procedure. Here we report this case and discuss its initial management along with a review of the literature.
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Rigaud J, Delavierre D, Sibert L, Labat JJ. [Management of chronic pelvic and perineal pain after suburethral tape placement for urinary incontinence]. Prog Urol 2010; 20:1166-74. [PMID: 21056399 DOI: 10.1016/j.purol.2010.08.046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Accepted: 08/16/2010] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The surgical treatment of stress urinary incontinence is essentially based on TVT or TOT suburethral tape placement. The purpose of this article is to review the literature on the diagnostic and therapeutic approach to chronic pelvic and perineal pain following suburethral tape placement for urinary incontinence. MATERIAL AND METHODS A comprehensive review of the literature was performed by searching Pubmed for articles on pelvic and perineal pain following suburethral tape placement. RESULTS The role of suburethral tape in the pathogenesis of pain is essentially based on the fact that pain occurs immediately or over the days following tape placement. The clinical features are usually fairly nonspecific, with pelvic myofascial pain, possibly associated with direct or indirect nerve lesions (obturator nerve or pudendal nerve). Local infiltration of anaesthetic along the tape is performed for diagnostic purposes to confirm the aetiology of the pain and can also have a temporary therapeutic efficacy. Surgical removal of the tape was performed with satisfactory intermediate-term results in about two out of three cases. CONCLUSION The frequency of chronic pelvic and perineal pain following suburethral tape placement appears to be underestimated. The diagnostic approach is based on complete clinical examination and infiltration along the tape and any nerves involved. Surgical removal of the tape provides the best intermediate-term analgesic results.
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Affiliation(s)
- J Rigaud
- Clinique urologique, centre fédératif de pelvipérinéologie, hôpital Hôtel Dieu, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France.
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Lee JKS, Agnew G, Dwyer PL. Mesh-related chronic infections in silicone-coated polyester suburethral slings. Int Urogynecol J 2010; 22:29-35. [DOI: 10.1007/s00192-010-1244-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Accepted: 07/31/2010] [Indexed: 10/19/2022]
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Delorme E, Hermieu JF. Recommandations concernant la prise en charge des complications des bandelettes sous-urétrales. Prog Urol 2010; 20 Suppl 2:S132-42. [DOI: 10.1016/s1166-7087(10)70007-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Araco F, Gravante G, DE Vita D, Konda D, Rombola P, Araco P, Piccione E. Obturator abscess with spread to the thigh after three years from a transobturator procedure. Aust N Z J Obstet Gynaecol 2009; 49:335-6. [PMID: 19566573 DOI: 10.1111/j.1479-828x.2009.00986.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Kaelin-Gambirasio I, Jacob S, Boulvain M, Dubuisson JB, Dällenbach P. Complications associated with transobturator sling procedures: analysis of 233 consecutive cases with a 27 months follow-up. BMC WOMENS HEALTH 2009; 9:28. [PMID: 19781074 PMCID: PMC2760512 DOI: 10.1186/1472-6874-9-28] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2009] [Accepted: 09/25/2009] [Indexed: 11/10/2022]
Abstract
Backround The transobturator tape procedure (TOT) is an effective surgical treatment of female stress urinary incontinence. However data concerning safety are rare, follow-up is often less than two years, and complications are probably underreported. The aim of this study was to describe early and late complications associated with TOT procedures and identify risk factors for erosions. Methods It was a 27 months follow-up of a cohort of 233 women who underwent TOT with three different types of slings (Aris®, Obtape®, TVT-O®). Follow-up information was available for 225 (96.6%) women. Results There were few per operative complications. Forty-eight women (21.3%) reported late complications including de novo or worsening of preexisting urgencies (10.2%), perineal pain (2.2%), de novo dyspareunia (9%), and vaginal erosion (7.6%). The risk of erosion significantly differed between the three types of slings and was 4%, 17% and 0% for Aris®, Obtape® and TVT-O® respectively (P = 0.001). The overall proportion of women satisfied by the procedure was 72.1%. The percentage of women satisfied was significantly lower in women who experienced erosion (29.4%) compared to women who did not (78.4%) (RR 0.14, 95% CI 0.05-0.38, P < 0.001). Conclusion Late post operative complications are relatively frequent after TOT and can impair patient's satisfaction. Women should be informed of these potential complications preoperatively and require careful follow-up after the procedure. Choice of the safest sling material is crucial as it is a risk factor for erosion.
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Affiliation(s)
- Isabelle Kaelin-Gambirasio
- Department of Gynecology and Obstetrics, Division of Gynecology, Perineology Unit, University Hospitals of Geneva, University of Geneva, Switzerland.
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Rardin CR, Moore R, Ward RM, Myers DL. Recurrent Thigh Abscess with Necrotizing Fasciitis from a Retained Transobturator Sling Segment. J Minim Invasive Gynecol 2009; 16:84-7. [DOI: 10.1016/j.jmig.2008.09.613] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2008] [Revised: 09/17/2008] [Accepted: 09/19/2008] [Indexed: 11/27/2022]
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Biomaterials in the treatment of pelvic organ prolapse and stress urinary incontinence: An update. CURRENT BLADDER DYSFUNCTION REPORTS 2008. [DOI: 10.1007/s11884-008-0023-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Geoffrion R, Murphy M, Mainprize T, Ross S. Closing the chapter on obtape: a case report of delayed thigh abscess and a literature review. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2008; 30:143-147. [PMID: 18254996 DOI: 10.1016/s1701-2163(16)32738-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND We report a case of delayed abscess formation 33 months after Obtape transobturator tape insertion, and we review the relevant literature. CASE A 73-year-old woman presented with groin pain, swelling, and purulent discharge 33 months after Obtape insertion. Examination showed a vaginal erosion and right groin abscess. Oral antibiotics resulted in significant symptomatic improvement. The patient underwent complete tape removal and drainage of infection. She continues to suffer from urinary incontinence. CONCLUSION Abscess formation and undiagnosed mesh erosion can occur up to 33 months after Obtape insertion, longer than previous reports have described. This highlights the need for continued vigilance in patients who have undergone Obtape insertion. Vaginal mesh erosions warrant careful repair in order to avoid delayed infectious complications.
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Affiliation(s)
- Roxana Geoffrion
- Department of Obstetrics and Gynaecology, University of Calgary, Calgary AB
| | - Magnus Murphy
- Department of Obstetrics and Gynaecology, University of Calgary, Calgary AB
| | - Tom Mainprize
- Department of Obstetrics and Gynaecology, University of Calgary, Calgary AB
| | - Sue Ross
- Department of Obstetrics and Gynaecology, University of Calgary, Calgary AB
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Stanford EJ, Paraiso MFR. A comprehensive review of suburethral sling procedure complications. J Minim Invasive Gynecol 2008; 15:132-45. [PMID: 18312981 DOI: 10.1016/j.jmig.2007.11.004] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2007] [Revised: 11/17/2007] [Accepted: 11/21/2007] [Indexed: 10/22/2022]
Abstract
The study objective was to review the existing literature regarding complications of anti-incontinence sling procedures. PubMed listings using keywords related to slings and associated complications with no date or language restrictions through May 2007 and the Manufacturer and User Facility Device Experience Database were searched for specific device- and procedure-related complications. Where no information was available, published abstracts were cited. Published reports of complications for all types of anti-incontinence sling procedures are analyzed and reported. Sling-related complications are multiple but can be summarized from studies on 13737 cumulative patients as involving: voiding dysfunction (8 studies, 881 patients, 16.3% average overall incidence [OI]); detrusor overactivity (20 studies, 1950 patients, 15.4% OI); urinary retention (14 studies, 943 patients, 14.2% OI); erosion/extrusion (19 studies, 2197 patients, 6.03% OI); impact on quality of life-dyspareunia (2 studies, 175 patients, 4.3% OI); infections-most often urinary tract infections but severe infections such as abscess are reported (19 studies, 1487 patients, 5.5% OI); hematoma-most often pelvic or vaginal (4 studies, 3691 patients, 2% OI); pain (6 studies, 597 patients, 7.3% OI); abdominal and pelvic organ injury-bladder, urethra, vagina, and intestines (10 studies, 1816 patients, 3.3% OI); systemic complications-deep vein thrombosis, sepsis (case reports); and death (case reports). Cure rates for all slings are as follows: subjective (16 studies, 1541 patients, 95% OI, range 63%-99%), objective (15 studies, 1203 patients, 82% OI, range 51%-97%), and failure (8 studies, 599 patients, 11.5% OI, range 4%-37%). It is likely that sling-related complications are under-reported in the published medical literature and in the Manufacturer and User Facility Device Experience Database. This review reports on the incidence of known complications for all types of slings. Some complications are common to all sling techniques; however, with development of minimally invasive slings, device-related complications are reported and compared.
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Gomelsky A, Dmochowski RR. Biocompatibility assessment of synthetic sling materials for female stress urinary incontinence. J Urol 2007; 178:1171-81. [PMID: 17698123 DOI: 10.1016/j.juro.2007.05.123] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2006] [Indexed: 11/17/2022]
Abstract
PURPOSE We evaluated the performance and complications of currently available synthetic sling materials with a focus on in vitro and in vivo biocompatibility, and acceptance in the human body. MATERIALS AND METHODS We reviewed the MEDLINE database for relevant literature pertaining to various synthetic sling materials. The Food and Drug Administration regulations regarding the regulation and biocompatibility testing of synthetic meshes were also reviewed. RESULTS Many synthetic meshes used for sling construction were introduced before rigorous Food and Drug Administration regulations were passed and, thus, some became associated with unique complications. Most meshes used in pubovaginal and mid urethral sling surgery are associated with high short-term success rates and relatively few intraoperative complications. Despite modifications and additives, slings constructed from polytetrafluoroethylene and polyethylene are poorly accepted by the human body. Flexible, macroporous, polypropylene meshes appear to integrate more completely with human tissue than other synthetic materials. However, multifilament and nonknitted polypropylene slings may integrate poorly. CONCLUSIONS The composition, weave and pore size of each material are unique. These properties are responsible for the strength and durability of the material, as well as the ultimate acceptance and incorporation in the human body. Each material should be individually evaluated and patients should be counseled appropriately before implantation.
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Affiliation(s)
- Alex Gomelsky
- Department of Urology, Louisiana State University Health Sciences Center-Shreveport, Shreveport, Louisiana, USA
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Roth TM. Management of persistent groin pain after transobturator slings. Int Urogynecol J 2007; 18:1371-3. [PMID: 17431534 DOI: 10.1007/s00192-007-0365-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2007] [Accepted: 03/15/2007] [Indexed: 10/23/2022]
Abstract
Prolonged groin pain after transobturator tape is uncommon. Three women reported groin pain that had not improved by 3 months postoperatively. Combined steroid and local anesthetic was effective for pain relief in all patients. The differential diagnosis of persistent groin pain after transobturator tape includes adductor muscle strain, osteitis pubis, obturator/groin abscess, structural adhesions, and inflammation, edema or nerve entrapment of the anterior branch of the obturator nerve. No side effects of treatment were noted. Patients that do not respond to local injection may require mesh dissection and excision.
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Affiliation(s)
- Ted M Roth
- Women's Specialty Center, Central Maine Medical Center, Lewiston, ME 04240, USA.
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Ismail SIMF. Mesh infection without erosion after ObTape sling insertion: a diagnostic challenge. Int Urogynecol J 2007; 18:1115-8. [PMID: 17333441 DOI: 10.1007/s00192-007-0312-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2006] [Accepted: 01/15/2007] [Indexed: 12/01/2022]
Abstract
Infection is a recognised complication of using synthetic mesh tapes in continence surgery. It has only been reported alongside erosion after trans-obturator sling insertion for urodynamic stress incontinence. A 41-year-old patient developed mesh infection. This infection was diagnosed 16 months after insertion, when it became an abscess and discharged through her groin. The condition was not suspected earlier, despite having examination under anesthesia and repeat cystoscopy. The patient recovered upon removing the mesh and remains continent. This case documents the possible development of mesh infection without erosion. It highlights the importance of taking this possibility into consideration when dealing with patients after continence surgery and explores how it can be detected.
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