Intraoperative Ultrasound-Guided Removal of Retained Mini Sling Anchor Causing Vaginal Pain: A Case Report

When and how to excise vaginal mesh

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.

Long-term outcomes of robotic mesh sacrocolpopexy

The aim of the study is to evaluate anatomic and functional late-term outcomes of robotic mesh sacrocolpopexy (RMS) at a single tertiary-care institution. Following IRB approval, a retrospective chart review of a prospectively collected database on consecutive patients who underwent RMS for symptomatic pelvic organ prolapse and had 3 year minimum follow-up was performed. Data collected included physical examination, validated questionnaires including Urogenital Distress Inventory, Incontinence Impact Questionnaire, and global Quality of Life (QOL). The primary outcome was failure defined as the need for re-operation and/or prolapse recurrence by examination. Those with office follow-up < 36 months underwent structured phone interviews. Between 12/2007 and 2/2012, 56 women underwent RMS. Thirty women had follow-up ≥ 3 years (median 64 (IQR 48-85) months). Mean C-point went from - 2.33 (range 0 to - 5) to - 9.00 (0 to - 12) (p < 0.01), and mean QOL score from 3.93 (0-10) to 1.93 (0-8) (p < 0.01). Two developed recurrent vault prolapse later on at 26 and 34 months, respectively. Four women (13%) required surgery for secondary prolapses, with three for anterior compartment and one for posterior compartment. Sixteen of twenty six were contacted via structured phone interviews, with 14 doing well, one deceased, and one who underwent a secondary posterior compartment prolapse 6 years later at an outside facility. This long-term study indicates durability for RMS in the management of symptomatic pelvic organ prolapse.