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Çetinel B, Kalender G, Kırlı EA, Yenilmez A, Gülpınar Ö, Şimşir A, Temeltaş G, Çubuk A, Can G. Unilateral J-cut division versus partial and subtotal removal techniques in female patients with mesh-related urethral obstruction: Multicentric comparative study. BJUI COMPASS 2024; 5:551-557. [PMID: 38873354 PMCID: PMC11168769 DOI: 10.1002/bco2.350] [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: 10/26/2023] [Revised: 02/01/2024] [Accepted: 02/11/2024] [Indexed: 06/15/2024] Open
Abstract
Objective To compare the functional (obstruction relieving) outcomes and complications of unilateral J-cut division, partial and subtotal vaginal removal techniques were performed for mesh-related urethral obstruction (MRUO) in females. Methods Patient review included demographics, a medical history and proforma with details of lower urinary tract symptoms (LUTS), physical and urodynamic findings, detailed surgical reports and follow-up data. Variables were compared between the three groups. Results Out of 130 patients with sling revision surgery (SRS), 54 women underwent SRS for MRUO with a median follow-up of 48 (17-96) months. Unilateral J-cut division, partial and subtotal vaginal removal techniques were performed in 12, 31 and 11 patients with a median duration of surgery of 30 (25-34), 40 (35-56) and 60 (60-70) minutes, respectively (p = 0.001). Statistically significant increase in median maximum free urine flow rate and decrease in median post-void residual urine volume were found after SRS in the three groups, while de novo stress urinary incontinence (SUI) developed in 10%, 44% and 60% of the patients in the unilateral J-cut division, partial and subtotal removal groups, respectively (p = 0.007). Conclusions The unilateral J-cut division technique was as effective as the partial and subtotal vaginal removal techniques in relieving MRUO with a shorter duration of surgery time (p = 0.001) and lower risk of de novo SUI (p = 0.007). Comparative studies with a larger number of patients are needed.
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Affiliation(s)
- Bülent Çetinel
- Cerrahpaşa Faculty of Medicine, Department of UrologyIstanbul University‐CerrahpaşaIstanbulTurkey
| | - Göktuğ Kalender
- Cerrahpaşa Faculty of Medicine, Department of UrologyIstanbul University‐CerrahpaşaIstanbulTurkey
| | - Elif Altınay Kırlı
- Cerrahpaşa Faculty of Medicine, Department of UrologyIstanbul University‐CerrahpaşaIstanbulTurkey
| | - Aydın Yenilmez
- Faculty of Medicine, Department of UrologyEskişehir Osmangazi UniversityEskişehirTurkey
| | - Ömer Gülpınar
- Faculty of Medicine, Department of UrologyAnkara UniversityAnkaraTurkey
| | - Adnan Şimşir
- Faculty of Medicine, Department of UrologyEge UniversityBornovaTurkey
| | - Gökhan Temeltaş
- Faculty of Medicine, Department of UrologyCelal Bayar UniversityManisaTurkey
| | - Alkan Çubuk
- Faculty of Medicine, Department of UrologyKırklareli UniversityKırklareliTurkey
| | - Günay Can
- Cerrahpaşa Faculty of Medicine, Department of Public HealthIstanbul University‐CerrahpaşaIstanbulTurkey
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2
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Tasmim S, Yousuf Z, Rahman FS, Seelig E, Clevenger AJ, VandenHeuvel SN, Ambulo CP, Raghavan S, Zimmern PE, Romero-Ortega MI, Ware TH. Liquid crystal elastomer based dynamic device for urethral support: Potential treatment for stress urinary incontinence. Biomaterials 2023; 292:121912. [PMID: 36434829 PMCID: PMC9772118 DOI: 10.1016/j.biomaterials.2022.121912] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 11/11/2022] [Indexed: 11/20/2022]
Abstract
Stress urinary incontinence (SUI) is characterized by the involuntary loss of urine due to increased intra-abdominal pressure during coughing, sneezing, or exercising. SUI affects 20-40% of the female population and is exacerbated by aging. Severe SUI is commonly treated with surgical implantation of an autologous or a synthetic sling underneath the urethra for support. These slings, however, are static, and their tension cannot be non-invasively adjusted, if needed, after implantation. This study reports the fabrication of a novel device based on liquid crystal elastomers (LCEs) capable of changing shape in response to temperature increase induced by transcutaneous IR light. The shape change of the LCE-based device was characterized in a scar tissue phantom model. An in vitro urinary tract model was designed to study the efficacy of the LCE-based device to support continence and adjust sling tension with IR illumination. Finally, the device was acutely implanted and tested for induced tension changes in female multiparous New Zealand white rabbits. The LCE device achieved 5.6% ± 1.1% actuation when embedded in an agar gel with an elastic modulus of 100 kPa. The corresponding device temperature was 44.9 °C ± 0.4 °C, and the surrounding agar temperature stayed at 42.1 °C ± 0.4 °C. Leaking time in the in vitro urinary tract model significantly decreased (p < 0.0001) when an LCE-based cuff was sutured around the model urethra from 5.2min ± 1min to 2min ±0.5min when the cuff was illuminated with IR light. Normalized leak point force (LPF) increased significantly (p = 0.01) with the implantation of an LCE-CB cuff around the bladder neck of multiparous rabbits. It decreased significantly (p = 0.023) when the device was actuated via IR light illumination. These results demonstrate that LCE material could be used to fabricate a dynamic device for treating SUI in women.
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Affiliation(s)
- Seelay Tasmim
- Department of Biomedical Engineering, Texas A&M University, College Station, TX, 77843, USA
| | - Zuha Yousuf
- Departments of Bioengineering and Biomedical Science, University of Houston, Houston, TX, 77004, USA
| | - Farial S Rahman
- Departments of Bioengineering and Biomedical Science, University of Houston, Houston, TX, 77004, USA
| | - Emily Seelig
- Department of Biomedical Engineering, Texas A&M University, College Station, TX, 77843, USA
| | - Abigail J Clevenger
- Department of Biomedical Engineering, Texas A&M University, College Station, TX, 77843, USA
| | - Sabrina N VandenHeuvel
- Department of Biomedical Engineering, Texas A&M University, College Station, TX, 77843, USA
| | - Cedric P Ambulo
- Materials and Manufacturing Directorate, Air Force Research Laboratory, Dayton, OH, 45433, USA
| | - Shreya Raghavan
- Department of Biomedical Engineering, Texas A&M University, College Station, TX, 77843, USA
| | - Philippe E Zimmern
- Department of Urology, The University of Texas Southwestern, Dallas, TX, 75390, USA
| | - Mario I Romero-Ortega
- Departments of Bioengineering and Biomedical Science, University of Houston, Houston, TX, 77004, USA
| | - Taylor H Ware
- Department of Biomedical Engineering, Texas A&M University, College Station, TX, 77843, USA.
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Allagany F, Dekalo S, Welk B. Endoscopic management of intraurethral mesh extrusion with the holmium:YAG laser is an acceptable treatment option in selected patients. Neurourol Urodyn 2022; 41:1511-1516. [PMID: 35731014 DOI: 10.1002/nau.24999] [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: 03/24/2022] [Revised: 06/05/2022] [Accepted: 06/13/2022] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Extrusion of transvaginal mesh into the urethra is a rare but potentially serious complication. Our objective is to evaluate the efficacy and long-term outcomes of women who underwent an endoscopic laser procedure to treat intraurethral mesh. MATERIALS AND METHODS A retrospective chart review identified women who underwent an endoscopic Holmium:YAG laser procedure to treat intraurethral mesh between September 2011-October 2021. Information about the procedure, symptoms, and level of incontinence was gathered from the medical records. Primary outcomes were the need for further procedures, and the Urinary Distress Index-6 score at last follow-up. RESULTS We identified a total of 29 women; mesh sling procedure included tension-free vaginal sling (19), transobturator sling (6), or other transvaginal mesh sling (4). Presentation of intraurethral mesh was a median of 6 (interquartile range [IQR]: 1-7) years after placement. After the endoscopic procedure, 18/29 (62%) women had no visible urinary mesh and complete resolution of their presenting symptoms. Retreatment was necessary in 3/29 women, and 6/29 (21%) reported new or worsening stress incontinence. The UDI-6 was completed by all patients at a median of 3.7 (IQR: 2.0-5.8) years after their endoscopic procedure. The median score was 22 (IQR: 11-44), and 18/29 (62%) women had scores in the asymptomatic range. UDI-6 scores were similar for the six women who had further mesh procedures and the ones who did not. CONCLUSIONS Endoscopic laser treatment of an eroded transvaginal mesh sling is an acceptable treatment with minimal morbidity and satisfactory UDI-6 scores after a median follow-up of 3.7 years.
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Affiliation(s)
- Feras Allagany
- Department of Obstetrics and Gynecology, Western University, London, Ontario, Canada
| | - Snir Dekalo
- Department of Surgery and Epidemiology and Biostatistics (Urologist), Western University, London, Ontario, Canada
| | - Blayne Welk
- Department of Surgery and Epidemiology and Biostatistics (Urologist), Western University, London, Ontario, Canada
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Chaus FM, Funk JT, Pangilinan J, Lin FC, Twiss CO. Total Autologous Fascia Lata Anterior and Apical Pelvic Organ Prolapse Repair: A New Technique and Initial Experience. Urology 2020; 137:190-195. [DOI: 10.1016/j.urology.2019.12.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 12/16/2019] [Accepted: 12/18/2019] [Indexed: 11/24/2022]
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5
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Tepe NB, Bayrak Ö, Şen H, Uğur MG, Erturhan S, Seçkiner İ. Comparison of the efficiency of partial versus subtotal mesh removal on urogenital distress and sexual functions after stress urinary incontinence surgery. Turk J Urol 2019; 46:140-145. [PMID: 31657696 DOI: 10.5152/tud.2019.19113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Accepted: 07/17/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To compare the efficiency of the partial mesh removal (PMR) versus subtotal mesh removal (SMR) on urogenital distress and sexual functions in patients who experienced vaginal mesh extrusion. MATERIAL AND METHODS Between June 2014 and January 2018, 45 patients who experienced vaginal mesh extrusion following midurethral sling surgeries and therefore underwent mesh excision were evaluated retrospectively. The effectiveness of PMR and SMR was compared using the "Urinary Distress Inventory-6 (UDI-6)" and "Female Sexual Function Index (FSFI)" forms, at the 6th month postoperatively. RESULTS Fourteen PMR-patients and 21 SMR-patients who met the study criteria were evaluated for the study. There was a significant improvement in UDI-6 scores and FSFI scores in both PMR and SMR groups at the 6th month postoperatively (p=0.001, p=0.001, p=0.001, and p=0.001, respectively). When the two groups were compared in terms of improvement rates, there was no significant difference in UDI-6 scores [(-)30.21±6.56% vs. (-)26.33±9.01%, p=0.222]. However, there was a statistically significant improvement in the FSFI scores in the SMR group [(+)83.71±14.81% vs. (+)124.42±36.82%, p=0.001]. There was no significant difference in overactive bladder symptoms between the two groups, with a decrease of 75% in the PMR group and 71.42% in the SMR group (p=0.721). Recurrent stress urinary incontinence was observed in two (14.2%) patients in the PMR group and four (19.1%) patients in the SMR group at the 6th month postoperatively (p=0.544). CONCLUSION In cases where extrusion is developed, subtotal/total mesh removal provides a significant improvement in patients' complaints of sexual dysfunction related to extrusion.
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Affiliation(s)
- Neslihan Bayramoğlu Tepe
- Department of Obstetrics and Gynecology, Gaziantep University School of Medicine, Gaziantep, Turkey
| | - Ömer Bayrak
- Department of Urology, Gaziantep University School of Medicine, Gaziantep, Turkey
| | - Haluk Şen
- Department of Urology, Gaziantep University School of Medicine, Gaziantep, Turkey
| | - Mete Gürol Uğur
- Department of Obstetrics and Gynecology, Gaziantep University School of Medicine, Gaziantep, Turkey
| | - Sakıp Erturhan
- Department of Urology, Gaziantep University School of Medicine, Gaziantep, Turkey
| | - İlker Seçkiner
- Department of Urology, Gaziantep University School of Medicine, Gaziantep, Turkey
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6
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Callewaert G, Housmans S, Cattani L, Pacquée S, D'Hoore A, Wyndaele J, Van der Aa F, Deprest J. Medium-term outcome of laparoscopic sacrocolpopexy using polivinylidene fluoride as compared to a hybrid polyglecaprone and polypropylene mesh: A matched control study. Neurourol Urodyn 2019; 38:1874-1882. [PMID: 31290173 DOI: 10.1002/nau.24083] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 06/07/2019] [Indexed: 11/11/2022]
Abstract
AIM To compare 2-year outcomes of laparoscopic sacrocolpopexy (LSCP) either with polyvinylidene fluoride (PVDF) or hybrid polypropylene containing a resorbable polyglecaprone (PP+ PG) mesh. MATERIALS AND METHODS Retrospective audit on 105 consecutive patients undergoing LSCP a with PVDF-mesh (DynaMesh, FEG Textiltechniken), matched by prolapse stage and cervicopexy or vault suspension to 105 controls undergoing LSCP with a hybrid PP + PG-mesh (Ultrapro, Ethicon). Patients are part of an ongoing prospective study. The primary outcome measure was the Patient Global Impression of Change score (PGIC), the coprimary variable was failure rate at the vault (≤1 cm). Other outcomes were intraoperative and postoperative complications within 3 months categorized by the Clavien-Dindo classification, reinterventions, graft-related complications (GRCs) and functional outcomes. All assessments were performed by an independent assessor. Data are reported as median (interquartile range) number and percent as appropriate, the Mann-Whitney U, χ2 , or Fisher exact were used for comparison. RESULTS Patient satisfaction in the PVDF group, as measured with the PGIC, was high (90.9% PGIC, ≥4) as well as was the anatomical success (97.3%) at a follow-up of 26 months. These outcomes were comparable to those of PP + PG-patients (84.8% PGIC, ≥4; 94.9% anatomical success). There were five patients (2.4%) with Dindo-III or higher complications and three patients had GRCs (1.5%), without differences between mesh type. Level-II posterior defects (Bp ≥ -1) were less likely in PVDF patients (34.1% vs 50% for PP + PG-patients; P = .003). Women in the PVDF group also were less bothered by prolapse (7.5% vs 26.4%; P = .001), yet they complained more of constipation (15.0% vs 9.0%; P = .01). CONCLUSION There were no differences in patient satisfaction and anatomical outcomes after LSCP either with PVDF or PP + PG mesh.
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Affiliation(s)
- Geertje Callewaert
- Pelvic Floor Unit, Department of Gynaecology, University Hospitals Leuven, Leuven, Belgium.,Academic Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Susanne Housmans
- Pelvic Floor Unit, Department of Gynaecology, University Hospitals Leuven, Leuven, Belgium
| | - Laura Cattani
- Pelvic Floor Unit, Department of Gynaecology, University Hospitals Leuven, Leuven, Belgium.,Academic Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Stefaan Pacquée
- Pelvic Floor Unit, Department of Gynaecology, University Hospitals Leuven, Leuven, Belgium.,Academic Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium
| | - André D'Hoore
- Pelvic Floor Unit, Department of Gastroenterology, University Hospitals Leuven, Leuven, Belgium.,Oncology and Biomedical Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Jan Wyndaele
- Pelvic Floor Unit, Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Frank Van der Aa
- Pelvic Floor Unit, Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium.,Academic Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Jan Deprest
- Pelvic Floor Unit, Department of Gynaecology, University Hospitals Leuven, Leuven, Belgium.,Academic Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium
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7
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Making surgery safer through adequate communication with the stakeholders: vaginal slings. World J Urol 2019; 38:1351-1358. [PMID: 31273442 DOI: 10.1007/s00345-019-02859-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 06/24/2019] [Indexed: 10/26/2022] Open
Abstract
PURPOSE In this review, we explore the evidence behind mid-urethral sling (MUS) surgery, review the rising reports of complications and the subsequent US Food and Drug Administration (FDA) and society statements, and evaluate risk perception and communication with patients, doctors, governing bodies, manufacturers and insurance companies. Our aim was to explore the pitfalls in communication that may be contributing to the decline in MUS use, and develop strategies to make MUS surgery safer. METHODS We searched the English language literature using PubMed for articles related to the management of stress urinary incontinence (SUI), MUS, safety and monitoring of transvaginal mesh (TVM), and reviewed all online FDA publications and international position statements regarding MUS for SUI. RESULTS Polypropylene mesh has been used in MUS since the 1990s, with robust evidence to support its use. There has been a decline in the use of MUS ever since the FDA notifications. In response to the controversy surrounding TVM, position statements have been released portending the safety of, and advocating for the continued use of, MUS for the management of SUI. CONCLUSIONS MUS is a viable, effective and safe treatment for SUI management. Physicians should obtain and document informed consent, be adequately trained, and monitor and report their outcomes using registries. With publication of registry results and ongoing health advocacy, the perception of the safety of MUS can improve and MUS can still be offered as a treatment option for SUI.
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8
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Syan R, Peyronnet B, Drain A, Enemchukwu E, Malacarne DR, Rosenblum N, Nitti VW, Brucker BM. Exploring stress urinary incontinence outcomes after sling excision for perforation or exposure. Low Urin Tract Symptoms 2019; 11:206-210. [PMID: 30900401 DOI: 10.1111/luts.12263] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 02/24/2019] [Accepted: 03/03/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study assessed stress urinary incontinence (SUI) outcomes after sling excision for urinary tract perforation or vaginal exposure, and compared the outcomes of concomitant versus staged autologous fascia pubovaginal sling (AFPVS). METHODS A retrospective chart review of all patients who underwent midurethral sling (MUS) excision for urinary tract perforation or vaginal exposure at a tertiary referral center between 2010 and 2015 was performed. Therapeutic strategies were categorized as concomitant AFPVS, staged AFPVS, and no anti-incontinence procedure. RESULTS In all, 32 patients were included for analysis: 13 with vaginal tape exposure (40.6%) and 19 with urinary tract tape exposure (59.4%). In patients who had SUI prior to sling excision (43.8%), the rate of resolved or improved SUI postoperatively was higher in the concomitant AFPVS group than in those who underwent sling excision alone (83.3% vs 12.5%, respectively; P = 0.03). Of 18 patients with no SUI prior to sling excision, 12 experienced recurrent SUI after sling removal (66.7%). The rate of recurrent SUI was lower in patients with vaginal MUS exposure than urinary tract MUS perforation, but this did not reach statistical significance (57.1% vs 72.7%, respectively; P = 0.63). The rates of resolved SUI after AFPVS were comparable in patients with concomitant and staged AFPVS (66.7% vs 71.4%, respectively; P = 0.99). CONCLUSIONS Many patients with MUS perforations or exposures will have SUI at initial presentation or develop SUI after removal of the synthetic sling. The decision to perform a concomitant AFPVS or to stage the surgical management of SUI can be individualized.
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Affiliation(s)
- Raveen Syan
- Department of Urology, New York University Langone Health, New York, New York
| | - Benoit Peyronnet
- Department of Urology, New York University Langone Health, New York, New York
| | - Alice Drain
- Department of Urology, New York University Langone Health, New York, New York
| | - Ekene Enemchukwu
- Department of Urology, New York University Langone Health, New York, New York
| | | | - Nirit Rosenblum
- Department of Urology, New York University Langone Health, New York, New York.,Department of Obstetrics and Gynecology, New York University Langone Health, New York, New York
| | - Victor W Nitti
- Department of Urology, New York University Langone Health, New York, New York.,Department of Obstetrics and Gynecology, New York University Langone Health, New York, New York
| | - Benjamin M Brucker
- Department of Urology, New York University Langone Health, New York, New York.,Department of Obstetrics and Gynecology, New York University Langone Health, New York, New York
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9
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Scott VCS, Oliver JL, Raz S, Kim JH. Robot-assisted laparoscopic sacrocolpopexy with autologous fascia lata: technique and initial outcomes. Int Urogynecol J 2019; 30:1965-1971. [DOI: 10.1007/s00192-019-03884-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 01/16/2019] [Indexed: 11/30/2022]
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10
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Eisenberg VH, Callewaert G, Sindhwani N, Housmans S, van Schoubroeck D, Lowenstein L, Deprest J. Ultrasound visualization of sacrocolpopexy polyvinylidene fluoride meshes containing paramagnetic Fe particles compared with polypropylene mesh. Int Urogynecol J 2018; 30:795-804. [PMID: 30083941 DOI: 10.1007/s00192-018-3728-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 07/17/2018] [Indexed: 02/06/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Paramagnetic Fe particles can be added during synthetic mesh production to allow visibility on magnetic resonance imaging. Our aim was to evaluate whether transperineal ultrasound (TPUS) allows visualization, measurement, and characterization of polyvinylidene fluoride (PVDF mesh) containing Fe particles compared with regular polypropylene (PP) meshes used for sacrocolpopexy. METHODS Women up to 1.5 years after laparoscopic sacrocolpopexy who were implanted with a PP or PVDF mesh underwent clinical examination and 2D, 3D, and 4D TPUS. Acquired volumes were analyzed offline for mesh position at rest and maximal Valsalva and for mesh dimensions and characteristics, with the operator blinded to group assignment. The two groups were compared. RESULTS There were 17 women in the PP and 25 in the PVDF mesh group, without differences in baseline demographics. None had significant prolapse, recurrence, symptoms, or complications. On TPUS, mesh was visible in all patients both caudally (perineal) and cranially but was more echogenic in the PVDF mesh group. Mesh length from distal to proximal that was visible on TPUS was longer for PVDF mesh, for both anterior and posterior vaginal arms (all P < 0.05), and for mesh above the vaginal apex (P = 0.002). The inferior aspects of the mesh showed areas of double mesh layers, suggesting folding in 80% of women in both groups, without symptoms. CONCLUSIONS PVDF mesh permits clearer visualization and is seen over a longer stretch on TPUS, with longer visible mesh arms. The latter can be due to differences in operative technique, presence of microparticles, implant textile structure, or patient characteristics.
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Affiliation(s)
- Vered H Eisenberg
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, 52621, Ramat Gan, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Geertje Callewaert
- Department of Obstetrics and Gynecology, UZ Leuven, Leuven, Belgium.,Academic Department Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Nikhil Sindhwani
- Department of Obstetrics and Gynecology, UZ Leuven, Leuven, Belgium.,Academic Department Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Susanne Housmans
- Department of Obstetrics and Gynecology, UZ Leuven, Leuven, Belgium.,Academic Department Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Dominique van Schoubroeck
- Department of Obstetrics and Gynecology, UZ Leuven, Leuven, Belgium.,Academic Department Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Lior Lowenstein
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
| | - Jan Deprest
- Department of Obstetrics and Gynecology, UZ Leuven, Leuven, Belgium.,Academic Department Development and Regeneration, KU Leuven, Leuven, Belgium.,Institute for Women's Health, University College London, London, UK
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11
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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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12
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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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Gomes CM, Carvalho FL, Bellucci CHS, Hemerly TS, Baracat F, de Bessa J, Srougi M, Bruschini H. Update on complications of synthetic suburethral slings. Int Braz J Urol 2017; 43:822-834. [PMID: 28266818 PMCID: PMC5678512 DOI: 10.1590/s1677-5538.ibju.2016.0250] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 12/05/2016] [Indexed: 01/10/2023] Open
Abstract
Synthetic suburethral slings have become the most widely used technique for the surgical treatment of stress urinary incontinence. Despite its high success rates, significant complications have been reported including bleeding, urethral or bladder injury, urethral or bladder mesh erosion, intestinal perforation, vaginal extrusion of mesh, urinary tract infection, pain, urinary urgency and bladder outlet obstruction. Recent warnings from important regulatory agencies worldwide concerning safety issues of the use of mesh for urogynecological reconstruction have had a strong impact on patients as well as surgeons and manufacturers. In this paper, we reviewed the literature regarding surgical morbidity associated with synthetic suburethral slings.
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Affiliation(s)
- Cristiano Mendes Gomes
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | | | | | - Thiago Souto Hemerly
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Fábio Baracat
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Jose de Bessa
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Miguel Srougi
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Homero Bruschini
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
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Przydacz M, Adli OEY, Mahfouz W, Loutochin O, Bégin LR, Corcos J. Structural differences and architectural features of two different polypropylene slings (TVT-O and I-STOP) have no impact on biocompatibility and tissue reactions. Cent European J Urol 2017; 70:154-162. [PMID: 28721282 PMCID: PMC5510338 DOI: 10.5173/ceju.2017.1189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 12/21/2016] [Accepted: 04/10/2017] [Indexed: 11/22/2022] Open
Abstract
Introduction To evaluate the impact of design features of the synthetic mid-urethral slings on tissue integrity and inflammatory responses. Material and methods In total 30 female Sprague-Dawley rats were implanted with type I monofilamentous, macroporous polypropylene meshes: Gynecare TVT-Obturator tape® (Ethicon Inc., Johnson & Johnson, Somerville, NJ, USA) and I-STOP® (CL Medical Inc., Lyon, France). All animal groups were sacrificed at set time intervals – 6 weeks, 3 months, 6 months, 9 months and 12 months – and the abdominal wall was harvested with mesh strips for histological evaluation. Results All mesh strips appeared to be well incorporated into the abdominal wall, and no signs of shrinkage was noticed. All specimens showed a thin/delicate, loose, fibrous interface between the synthetic graft plate and abdominal wall, along with mild inflammatory reactions from 6 weeks to 12 months. Conclusions Both mesh brands induced comparable, minimal foreign body reactions and integrated well into the host tissues despite differences in architectural features. TVT-O® and I-STOP® evoked similar low-grade inflammatory responses up to 12 months in this animal model. Structural differences and architectural features of polypropylene slings used in this study have had no impact on tissue integrity and inflammatory responses.
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Affiliation(s)
- Mikolaj Przydacz
- Department of Urology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Oussama El Yazami Adli
- Department of Urology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Wally Mahfouz
- Department of Urology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Oleg Loutochin
- Department of Urology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Louis R Bégin
- Division of Anatomical Pathology, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada
| | - Jacques Corcos
- Department of Urology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
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15
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Ackerman AL, Raz S. Author Reply. Urology 2017; 106:208-209. [PMID: 28571735 DOI: 10.1016/j.urology.2017.01.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- A Lenore Ackerman
- Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Shlomo Raz
- David Geffen School of Medicine at UCLA, Los Angeles, CA
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Balzarro M, Rubilotta E, Porcaro AB, Trabacchin N, Sarti A, Cerruto MA, Siracusano S, Artibani W. Long‐term follow‐up of anterior vaginal repair: A comparison among colporrhaphy, colporrhaphy with reinforcement by xenograft, and mesh. Neurourol Urodyn 2017; 37:278-283. [DOI: 10.1002/nau.23288] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 03/17/2017] [Indexed: 01/23/2023]
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Postoperative Urinary Retention and Urinary Tract Infections Predict Midurethral Sling Mesh Complications. Urology 2017; 99:42-48. [DOI: 10.1016/j.urology.2016.10.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 10/07/2016] [Accepted: 10/11/2016] [Indexed: 11/20/2022]
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Huber SA, Chinthakanan O, Hawkins S, Miklos JR, Moore RD. Laparoscopic Burch urethropexy at time of mesh sling removal: A cohort study evaluating functional outcomes and quality of life. World J Obstet Gynecol 2016; 5:210-217. [DOI: 10.5317/wjog.v5.i3.210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Revised: 04/30/2016] [Accepted: 06/03/2016] [Indexed: 02/05/2023] Open
Abstract
AIM: To theorize that performing a laparoscopic Burch urethropexy at time of sling removal would significantly decrease subjective symptoms of stress urinary incontinence (SUI) and improve patient satisfaction.
METHODS: Women who underwent a combined sling removal and laparoscopic Burch procedure between 2009 and 2014 were matched via age and sling-type in a 1:2 ratio to women who only underwent a sling removal. Those who underwent surgery within 6 mo of data collection were excluded from the study, as were women who underwent multi-stage surgery. Preoperative assessment for both groups included a focused clinical exam with or without functional testing and questionnaires including urogenital distress inventory-6 (UDI-6) and incontinence impact questionnaire-7 (IIQ-7) per the standard clinical practice. All non-exempt women were sent a questionnaire that included UDI-6 and IIQ-7 in addition to standard follow-up questions. Research staff contacted participants via email, mail, and telephone using the same questionnaire template and script. Data was analyzed by using χ2 test for categorical data, and Student’s t test and Wilcoxon Rank Sum test for continuous data. The measure of effect was determined by logistic regression analysis.
RESULTS: A total of 48 women out of 146 selected patients were successfully recruited with n = 22 in the Burch cohort and n = 26 in the control cohort. The mean age was 54.7 ± 7.8 years and mean body mass index was 22.0 ± 13.9 kg/m2. The majority of patients were Caucasian (73.3%), postmenopausal (91.1%), nonsmokers (57.9%), with a history of hysterectomy (81.4%). Six nineteen point six percent of women presented after at least 2 years from placement, which was significantly more common in the Burch cohort. Pain was the most common chief complaint (64.4%) in both groups at the time of initial presentation, and 78.9% of women reported concomitant urinary incontinence. There was no significant difference in pre-operative UDI-6 and IIQ-7 scores between the two cohorts. However, the change in UDI-6 score postoperatively was significantly improved in the Burch cohort with an average drop in score of 28.41 points compared to a decrease of 4.01 points in the control group (P = 0.02, 95%CI: 3.84 to 44.97). Although not statistically significant, the Burch cohort was 58% more likely to show an overall improvement in their score after surgery and 40% more likely to meet the minimal important difference of 11 points (RR = 1.58, 95%CI: 0.97 to 2.57; RR 1.40, 95%CI: 0.79 to 2.46). The difference in IIQ scores was nonsignificant. There was no significant difference in blood loss, complications, or postoperative pain or dyspareunia.
CONCLUSION: Performing a Burch urethropexy during sling removal does not increase complication rates and results in a significant change in validated symptom-related quality of life scores.
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Cohen SA, Raz S. Use of synthetic grafts in pelvic reconstruction: A path of continued discovery. World J Clin Urol 2016; 5:11-17. [DOI: 10.5410/wjcu.v5.i1.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 01/11/2016] [Accepted: 02/16/2016] [Indexed: 02/06/2023] Open
Abstract
Since the 1990s, mesh has been used in pelvic reconstruction to augment repairs for stress urinary incontinence and pelvic organ prolapse (POP). In 2008 and 2011, the United States Food and Drug Administration (FDA) issued Public Health Notifications ultimately informing providers and the public that complications associated with the use of synthetic mesh in the transvaginal repair of POP are not rare. In this review, we (1) examine literature characterizing surgical practice-patterns subsequent to the FDA announcements; (2) describe presentation of mesh-associated complications and outcomes of management; (3) discuss the most recent materials science research; and (4) seek to characterize whether or not mesh has lived up to the long-term efficacy promise of a permanent implant. Durability of mesh-augmented anatomical outcomes do not consistently translate into improved patient satisfaction and subjective outcomes. This, when coupled with the possibility of mesh-associated complications, emphasizes the need for continued innovation beyond the status quo of current synthetic grafts.
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