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Chaudhry Z, Kreydin E, Oliver J, Raz S. Predictors of prolonged hospitalization and perioperative complications following mid-urethral sling mesh removal. World J Urol 2022; 40:1793-1797. [PMID: 35534576 DOI: 10.1007/s00345-022-04021-3] [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: 12/14/2021] [Accepted: 04/19/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To assess preoperative and perioperative characteristics associated with increased length of stay and major complications after mid-urethral sling mesh removal. METHODS We performed an IRB-approved retrospective analysis of patients who underwent mid-urethral sling mesh removal. Demographic data and baseline surgical characteristics were collected. Operative reports and hospital/clinic notes were reviewed for complications which were categorized using the Clavien-Dindo Classification scheme. Length of stay was deemed abnormal if greater than 1 day. Complications were assessed using multivariate regression analysis. RESULTS A total of 468 patients were identified as having undergone mid-urethral sling mesh removal. Mean age was 56 (± 11.1). 431 patients had either retropubic or transobturator slings. 241 patients underwent retropubic or groin exploration as a part of their mesh removal. A prolonged length of stay was noted in 73 patients (15.6%) and 13 patients (2.8%) experienced a Clavien Grade 3 complication. Pre-operative narcotic/benzodiazepine use, concomitant surgical procedure, bladder injury, increased ASA class, and major complications had an increased odds of a prolonged length of stay. Patients who experienced a bladder injury, groin/suprapubic incision, and estimated blood loss of over 400 mL had an increased odds of Clavien Grade 3 complications. CONCLUSIONS Patient characteristics and perioperative factors are associated with increased length of stay and major complications after mid-urethral sling mesh removal.
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Affiliation(s)
| | - Evgeniy Kreydin
- Catherine and Joseph Aresty Department of Urology, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Janine Oliver
- Division of Urology, Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Shlomo Raz
- Division of Pelvic Medicine and Reconstructive Surgery, Department of Urology, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
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Rodrigues P, Raz S. The Burden of Reoperations and Timeline of Problems in 1,530 Cases of Mesh-Related Complications. Urol Int 2021; 106:235-242. [PMID: 33887745 DOI: 10.1159/000514389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 01/07/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Mesh-related complications resulting from pelvic organ prolapse (POP) reconstruction operations may be a devastating experience leading to multiple and complex interventions. OBJECTIVES The aim of the study was to describe the experience and time frame of management of mesh-related complications in women treated for POP or stress urinary incontinence in a tertiary center. METHODS 1,530 cases of mesh-related complications were accessed regarding their clinical presentation, number of surgeries, and timeline of surgical treatments to treat multiple clinical complaints until the ultimate operation where all the meshes were removed in a single tertiary center. RESULTS The studied population revealed to be a highly referred one with only 10.2% of the cases implanted at our center. Clinical presentation varied widely with 48.7% referring pain as the chief complaint, while 31.3% complained of voiding dysfunctions, 2.5% reported genital prolapses, 2.2% complained of vaginal problems, and 1.2% noted intestinal problems as the main clinical complaint. Only 4.8% of the cases presented mesh erosion at examination; 57.8% of the cases required more than 1 operation to address the mesh-related problems. Sixty-eight cases had more than 10 operations up to complete removal. Three clusters of patients could be identified: (i)-those from whom the mesh was promptly removed after clinical problems emerged, (ii) those with slowly evolving problems, and (iii) those with escalating problems despite treatment attempts. CONCLUSIONS Mesh-related complications after pelvic floor reconstruction are an evolving disease with diverse clinical presentation. The identified time-related problems and the multiple failed attempts to treat their complications warrant attention with continuous monitoring of these patients and aggressive removal of the mesh if the clinical complaint cannot be swiftly managed.
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Affiliation(s)
- Paulo Rodrigues
- Division of Pelvic Medicine and Reconstructive Surgery, University of California Los Angeles-UCLA, São Paulo, Brazil
| | - Shlomo Raz
- Division of Pelvic Medicine and Reconstructive Surgery, University of California Los Angeles-UCLA, São Paulo, Brazil
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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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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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Morselli S, Li Marzi V, Verrienti P, Serati M, Di Camillo M, Tosto A, Milanesi M, Serni S. Transvaginal mesh surgery for pelvic organ prolapse does not affect sexual function at long term follow up. Eur J Obstet Gynecol Reprod Biol 2019; 240:282-287. [PMID: 31352129 DOI: 10.1016/j.ejogrb.2019.07.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 07/16/2019] [Accepted: 07/20/2019] [Indexed: 01/24/2023]
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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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Bergersen A, Hinkel C, Funk J, Twiss CO. Management of vaginal mesh exposure: A systematic review. Arab J Urol 2019; 17:40-48. [PMID: 31258942 PMCID: PMC6583711 DOI: 10.1080/2090598x.2019.1589787] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2018] [Indexed: 11/25/2022] Open
Abstract
Objectives: To identify various predisposing factors, the clinical presentation, and the management of vaginal mesh-related complications, with special emphasis on mesh exposure and the indications for and results of vaginal mesh removal. Methods: A systematic literature review was performed using a search strategy based on the Preferred Reporting Items for Systematic Reviews and Meta-analyses criteria. PubMed was queried for studies regarding aetiology, risk factors, and management of vaginal mesh exposure from 1 January 2008 to June 2018. Full-text articles were obtained for eligible abstracts. Relevant articles were included, and the cited references were used to identify relevant articles not previously included. Results: A total of 102 abstracts were identified from the PubMed search criteria. An additional 45 studies were identified based on review of the cited references. After applying eligibility criteria and excluding impertinent articles, 58 studies were included in the final analysis. Conclusion: Numerous studies have found at least some degree of symptomatic improvement regardless of the amount of mesh removed. Focal areas of exposure or pain can be successfully managed with partial mesh removal with low rates of complications. With partial mesh removal, many patients will ultimately require subsequent mesh removal procedures. For this reason, complete mesh excision is an alternative for patients with diffuse vaginal pain, large mesh exposure, and extrusion of mesh into adjacent viscera. However, when considering complete mesh removal, it is important to counsel patients regarding possible complications of removal and the increased risk of recurrent stress urinary incontinence and pelvic organ prolapse postoperatively. Abbreviations: MUS: midurethral sling; OR: odds ratio; POP: pelvic organ prolapse; PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-analyses; SUI: stress urinary incontinence; TOT: transobturator; TVT: tension-free vaginal tape
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Affiliation(s)
- Andrew Bergersen
- Department of Surgery, Division of Urology, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Cameron Hinkel
- Department of Surgery, Division of Urology, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Joel Funk
- Department of Surgery, Division of Urology, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Christian O Twiss
- Department of Surgery, Division of Urology, University of Arizona College of Medicine, Tucson, AZ, USA
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Impact of the mid-urethral sling for stress urinary incontinence on female sexual function and their partners’ sexual activity. Taiwan J Obstet Gynecol 2018; 57:853-857. [DOI: 10.1016/j.tjog.2018.10.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2018] [Indexed: 11/23/2022] Open
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Abstract
PURPOSE OF REVIEW Since 2011, there has been increasing attention paid to the use of synthetic grafts (mesh) in pelvic reconstructive surgery. Although synthetic grafts are considered permanent implants to improve outcomes, the use of this material has created inadvertent complications such as erosion, chronic pain, and dyspareunia. Patient evaluation is complex and surgical techniques carry risks not yet completely understood. This review summarizes current opinions in synthetic graft excision for the treatment of mesh-related complications. RECENT FINDINGS Recent studies reveal excisions are being increasingly performed and graft placement is decreasing. Patients of lower-volume surgeons have a higher risk of complication and need for excisional procedures. Pain is becoming the most common indication for vaginal mesh excision and that pain is mostly elicited with palpation of the mesh arms. Explantation is technically challenging and carries significant risks. SUMMARY Vaginal synthetic graft complications are increasingly being managed by surgical excision. Careful evaluation of patient symptoms and objective findings should help guide management. Surgeons considering operative management should counsel patients regarding the risks of excision including but not limited to hemorrhage, nerve damage, muscular injury, and recurrent symptoms.
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Rac G, Greiman A, Rabley A, Tipton TJ, Chiles LR, Freilich DA, Rames R, Cox L, Koski M, Rovner ES. Analysis of Complications of Pelvic Mesh Excision Surgery Using the Clavien-Dindo Classification System. J Urol 2017; 198:638-643. [PMID: 28433641 DOI: 10.1016/j.juro.2017.04.078] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE We describe and categorize complications using the Clavien-Dindo classification system in patients who underwent vaginal mesh excision surgery. MATERIALS AND METHODS With institutional review board approval we retrospectively reviewed the records of 277 patients who underwent vaginal mesh extraction between 2007 and 2015 at a single institution. Surgical complications were stratified using the Clavien-Dindo classification system. Complications were perioperative (prior to discharge) or postoperative (within 90 days). Indications for initial mesh placement, mesh revision procedure, time to resolution and medical comorbidities were assessed. RESULTS Of the 277 patients 47.3% had at least 1 surgical complication, including multiple complications in 7.2%. A total of 155 complications were identified, which were grade II in 49.0% of cases, grade I in 25.8%, grade IIIb in 18.7%, grade IIIa in 5.2% and grade IVa in 1.3%. No grade IVb or V complications were identified. The indication for initial mesh placement did not significantly affect complication frequency. Patients who underwent combined stress urinary incontinence and pelvic organ prolapse mesh revision surgeries had an increased frequency of complications compared to those treated with mesh revision surgery for pelvic organ prolapse or stress urinary incontinence alone (p = 0.045). Most complications occurred postoperatively and resolved by 90 days. Age, body mass index, smoking status and diabetes were not associated with increased complications. CONCLUSIONS Despite the complexity of mesh revision surgery most complications are minor. Serious complications may develop, emphasizing the need for proper patient counseling and surgical experience when performing these procedures.
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Affiliation(s)
- Goran Rac
- Department of Urology, Medical University of South Carolina, Charleston, South Carolina; Urology of Kaiser Permanente Medical Center (MK), San Diego, California
| | - Alyssa Greiman
- Department of Urology, Medical University of South Carolina, Charleston, South Carolina; Urology of Kaiser Permanente Medical Center (MK), San Diego, California
| | - Andrew Rabley
- Department of Urology, Medical University of South Carolina, Charleston, South Carolina; Urology of Kaiser Permanente Medical Center (MK), San Diego, California
| | - T J Tipton
- Department of Urology, Medical University of South Carolina, Charleston, South Carolina; Urology of Kaiser Permanente Medical Center (MK), San Diego, California
| | - Leah R Chiles
- Department of Urology, Medical University of South Carolina, Charleston, South Carolina; Urology of Kaiser Permanente Medical Center (MK), San Diego, California
| | - Drew A Freilich
- Department of Urology, Medical University of South Carolina, Charleston, South Carolina; Urology of Kaiser Permanente Medical Center (MK), San Diego, California
| | - Ross Rames
- Department of Urology, Medical University of South Carolina, Charleston, South Carolina; Urology of Kaiser Permanente Medical Center (MK), San Diego, California
| | - Lindsey Cox
- Department of Urology, Medical University of South Carolina, Charleston, South Carolina; Urology of Kaiser Permanente Medical Center (MK), San Diego, California
| | - Michelle Koski
- Department of Urology, Medical University of South Carolina, Charleston, South Carolina; Urology of Kaiser Permanente Medical Center (MK), San Diego, California
| | - Eric S Rovner
- Department of Urology, Medical University of South Carolina, Charleston, South Carolina; Urology of Kaiser Permanente Medical Center (MK), San Diego, California.
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Characteristics of Providers Performing Urogynecologic Procedures on Medicare Patients 2012-2014. Female Pelvic Med Reconstr Surg 2017; 23:75-79. [PMID: 28230614 DOI: 10.1097/spv.0000000000000349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To analyze the characteristics of providers performing stress urinary incontinence (SUI) and pelvic organ prolapse (POP) procedures in the United States. METHODS The Centers for Medicare Services public database, released for years 2012 through 2014, was queried for SUI-related and POP-related Healthcare Common Procedure Coding System. Providers were categorized as Female Pelvic Medicine and Reconstructive Surgery (FPMRS) providers and non-FPMRS providers, using a list of FPMRS board-certified providers compiled through the American Board of Medical Subspecialties website. Other physician specialties that submitted SUI and POP procedures claims were tabulated. RESULTS Six hundred twenty-nine FPMRS and 833 non-FPMRS providers submitted claims for SUI and POP procedures. The SUI procedures claims had the following provider specialty distribution: obstetrics and gynecology (OB/GYN)-FPMRS, 46.7%; urology, 26.3%; OB/GYN, 12.2%; and urology-FPMRS, 13.9%, with the remaining 0.9% being performed by other specialties. The POP procedures had the following specialty distribution: OB/GYN-FPMRS, 63.4%; OB/GYN, 16.7%; urology, 8.3%; and urology-FPMRS, 7.1%, with the remaining 4.5% being performed by other specialties.Provider distribution was compared between transvaginal mesh and sling insertion procedures to transvaginal mesh and sling removal procedures. The FPMRS providers claimed 63.6% of sling and transvaginal mesh insertion procedures and performed 84.9% of mesh and sling removal procedures. CONCLUSIONS Medicare reimbursement data provides a unique insight into the distribution of provider specialties performing SUI-related and POP-related procedures in the Medicare population. The OB/GYN-FPMRS providers submitted the majority of claims for SUI and POP procedures from 2012 to 2014. The FPMRS providers are also performing the majority of mesh removal procedures.
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Abstract
OBJECTIVE The objective of this study was to investigate the ultrasound characteristics of vaginal mesh in women with vaginal mesh complications. METHODS This was a cross-sectional study of women presenting with extrusion complications from vaginal mesh kit for prolapse at our tertiary care center between years 2009 and 2014. We included women who concurrently underwent a 3-dimensional endovaginal ultrasound (EVUS) as part of the clinical evaluation. We excluded women with incomplete charts and poor imaging quality. Subjects were categorized by the presence or absence of associated pelvic pain. Based on ultrasound findings, we compared the location of mesh, the appearance of mesh pattern (flat, folding, prominence, convoluted), and other EVUS characteristics of mesh. RESULTS Forty-six women with vaginal mesh complications and good image quality were included. When comparing mesh length between posterior and anterior compartments, the posterior meshes were significantly longer than the anterior meshes (42.1 [SD, 11.9] mm vs 25.8 [SD, 9] mm; P < 0.0001) and more often associated with pain. In the posterior compartment, the mean mesh length seen on EVUS was significantly longer in women with pain than in women without pain (46.5 [SD, 9] mm vs 31.8 [SD, 12.1] mm; P = 0.0001). There was also a higher proportion of a "flat" mesh pattern, 14 (58.3%) of 25, in the posterior compartment associated with the presence of pain (P = 0.013). In the posterior compartment, a smaller distance between the distal edge of the mesh and the anal sphincter was significantly associated with the presence of pain (8 mm [0-37] vs 21 mm [8-35], P = 0.024). In both compartments, the EVUS had 100% sensitivity for detection of mesh extrusions. CONCLUSIONS In this population of patients presenting with mesh complications, the posterior meshes were more often visualized as a "flat" pattern with a higher frequency of pain. Mesh complications of the anterior compartment had a higher frequency of folding and shrinkage.
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Kelly EC, Winick-Ng J, Welk B. Surgeon Experience and Complications of Transvaginal Prolapse Mesh. Obstet Gynecol 2016; 128:65-72. [DOI: 10.1097/aog.0000000000001450] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Native Tissue Surgery for Prolapse versus Graft/Mesh Use: Current Trends in Reconstructive Surgery. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2016. [DOI: 10.1007/s13669-016-0147-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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