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Ripa F, Enikeev D, Talyshinskii A, Juliebø-Jones P, Tzelves L, Kallidonis P, Somani B. Should endoscopic laser excision be offered as the first-line management for patients with eroded mesh? Outcomes of a systematic review of literature. Curr Opin Urol 2024; 34:135-144. [PMID: 37933676 DOI: 10.1097/mou.0000000000001146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
PURPOSE OF REVIEW Mesh erosions following previous synthetic sling/mesh surgery for stress urinary incontinence (SUI) have become increasingly common. This systematic review provides evidence for the role of laser excision as a first-line management in patients with eroded mesh. RECENT FINDINGS Fourteen articles (173 patients) were included for the final review. Among these, 138 patients (79.8%) were submitted to trans-urethral laser excision of eroded urethral/bladder mesh over a median time to presentation of 36.6 months. Over a median follow-up of 23.6 months, 88 (63.7%) reported a complete resolution, 32 (23.2%) reported persistence or recurrence of SUI and 17 (12.3%) presented with recurrent mesh erosion. The success rate after a single endoscopic procedure was 66.5, vs. 93.5% after additional endoscopic procedures, with only 9 (6.6%) requiring open surgical excision. Overall, there were seven (5.1%) postoperative complications including two urethrovaginal fistulas, two UTIs and haematuria each, and one case of urethral diverticulum. SUMMARY Laser excision of eroded mid-urethral slings into either the bladder or urethra is a challenging complication of minimally invasive incontinence surgery. Laser excision was able to achieve a good success rate with single or staged endoscopic procedure with a low risk of complication. It represents a valid first treatment option, although patients should be managed in mesh referral centres in collaboration with uro-gynaecology teams.
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Affiliation(s)
- Francesco Ripa
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Dmitry Enikeev
- Department of Urology, Medical University of Vienna, Vienna, Austria
- Urology Department, Rabin Medical Center, Petah Tikva, Israel
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Ali Talyshinskii
- Department of Urology, Astana Medical University, Astana, Kazakhstan
| | - Patrick Juliebø-Jones
- Department of Urology Haukeland and Department of Clinical Medicine, University Hospital, Bergen, Norway
| | - Lazaros Tzelves
- Department of Urology, University College of London Hospital, London, UK
| | | | - Bhaskar Somani
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Frigerio M, Barba M, Marino G, Volonte S, Cola A. Pelvic floor ultrasound evaluation in the diagnosis of exposure of synthetic implanted materials in the lower urinary tract. Int J Gynaecol Obstet 2023; 163:834-839. [PMID: 37332147 DOI: 10.1002/ijgo.14933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 04/29/2023] [Accepted: 05/28/2023] [Indexed: 06/20/2023]
Abstract
OBJECTIVE To evaluate the diagnostic performance of pelvic floor ultrasound (PFUS) to recognize prosthetics exposure in the bladder and/or urethra in women with lower urinary tract symptoms (LUTS). METHODS A cross-sectional study evaluating patients with LUTS after mesh/sling surgery. PFUS was performed with both transvaginal (TVUS) and translabial (TLUS) approaches. A distance of 1 mm or less from the bladder and/or urethra was considered highly suspect for mesh exposure. After PFUS, patients underwent diagnostic urethrocystoscopy. RESULTS A total of 100 consecutive women were analyzed. According to urethrocystoscopy, the rate of tape exposure in the lower urinary tract was 3%. PFUS showed 100% sensitivity and 98%-100% specificity in detecting lower urinary tract mesh exposure. The negative predictive value was 100% and the positive predictive value ranged from 33% to 50% for urethral and 100% for bladder exposure. CONCLUSIONS PFUS represents an effective and reliable non-invasive screening test to exclude prosthetics exposure in the bladder and/or urethra in women with LUTS.
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Affiliation(s)
| | | | | | | | - Alice Cola
- Monza-Ospedale San Gerardo, Monza, Italy
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Anderson K, Perrouin‐Verbe M, Bridgeman‐Rutledge L, Skews R, Hashim H. Cystoscopic removal of transvaginal mesh: Long-term outcomes. BJUI COMPASS 2023; 4:543-548. [PMID: 37636201 PMCID: PMC10447205 DOI: 10.1002/bco2.254] [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: 03/19/2023] [Accepted: 05/07/2023] [Indexed: 08/29/2023] Open
Abstract
Objectives This study's aim is to evaluate the long-term quality of life and functional outcomes following cystoscopic excision of stress urinary incontinence (SUI) and pelvic organ prolapse (POP) mesh extruded into the urinary tract in women. Patients and Methods A retrospective chart review was performed of all cases of cystoscopic removal of extruded mesh at our high-volume tertiary care centre between April 2013 and August 2021. Postoperative patient-reported outcomes were collected via questionnaires: Urogenital Distress Inventory Short Form (UDI-6), EQ-5D-5L Visual analogue scale, ICIQ-Satisfaction (ICIQ-S) and additional questions regarding postoperative sexual function. Results During the study period, 27 women with a median age of 61 years (45-87) underwent cystoscopic mesh removal surgery using either Ho-YAG laser (56%) or bipolar loop resection (44%). The most common presentation of mesh extrusion was recurrent urinary tract infections (67%). Other presenting complaints were pain (41%), urinary urgency ± incontinence (41%) and voiding difficulties (18%). Long-term follow-up outcomes from 20 patients (median follow-up: 24 months) showed that mesh removal was rated successful by 80%, and 100% would choose to have the surgery again if in the same situation. Recurrent SUI was reported by 45% of respondents, and urinary urge incontinence was found in 50%. For patients who answered the sexual function questions, 50% reported improved sexual function postmesh removal (6/12). Conclusions Cystoscopic removal of extruded female SUI and POP mesh is associated with high patient satisfaction and low morbidity in appropriately selected patients at 2-year median follow-up. A patient-centred shared decision-making process is essential in counselling patients regarding options and expected outcomes following mesh removal surgery.
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Affiliation(s)
| | | | | | - Rachel Skews
- Bristol Urological Institute, Southmead HospitalBristolUK
| | - Hashim Hashim
- Bristol Urological Institute, Southmead HospitalBristolUK
- Bristol Medical SchoolUniversity of BristolBristolUK
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Zamecnik L, Martan A, Svabik K, Masata J. Laparoscopic removal of intravesically inserted transobturator tape. Int Urogynecol J 2021; 32:3309-3312. [PMID: 34115163 DOI: 10.1007/s00192-021-04857-0] [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: 11/28/2020] [Accepted: 05/12/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The aim of this video is to provide a step-by-step description of our approach to the surgical management of intravesically localized transobturator tape after previous failure of repeated cystoscopic tape resection. METHODS This video presents a patient with tape erosion to the urinary bladder after repeated cystoscopic tape resection, recurrent stone formation, and repeated lithotripsy, with recurrent urinary tract infections and overactive bladder (OAB) with urgency incontinence. RESULTS During the laparoscopy procedure tape was identified in the left obturator muscle, cut near the obturator muscle, and dissected up to the bladder wall. Afterward, a vertical 2-cm incision was made in the bladder wall, the stone was removed, and the rest of the tape was dissected from the bladder wall. A two-layer suture of the bladder wall was performed. The postoperative course was uneventful. In follow-up visits 3 and 6 months after surgery the patient was continent with no symptoms of OAB. CONCLUSIONS Cystoscopic resection of protruded mesh is inadequate in many cases. In such cases the mesh should be removed from the urinary bladder wall completely. Laparoscopy allows minimally invasive complete removal of the tape, combining resection of the extravesical and intravesical parts of the tape.
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Affiliation(s)
- Libor Zamecnik
- Urology Department, 1st Faculty of Medicine, Charles University and General University Hospital
- , Prague, Czech Republic
| | - Alois Martan
- Department of Obstetrics and Gynecology, 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Kamil Svabik
- Department of Obstetrics and Gynecology, 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Jaromir Masata
- Department of Obstetrics and Gynecology, 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic.
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Jones SL, Guo Y, Nguyen L. Case - Resolution of urethral mesh perforation after sling: The migrating mesh. Can Urol Assoc J 2020; 15:E184-E186. [PMID: 32807278 DOI: 10.5489/cuaj.6645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Sara Luisa Jones
- Dalhousie Medical School, Dalhousie University, Halifax, NS, Canada
| | - Yanbo Guo
- Division of Urology, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Laura Nguyen
- Division of Urology, Department of Surgery, McMaster University, Hamilton, ON, Canada
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Dunn AJ, Dengler KL, Gruber DD, Osborn DJ. Endoscopic management of transvaginal mesh kit bladder extrusion: A case report and literature review. JOURNAL OF CLINICAL UROLOGY 2020. [DOI: 10.1177/2051415820937193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: A rare complication of transvaginal synthetic mesh kits is bladder mesh extrusion. Treatment options include abdominal or vaginal surgical mesh excision or endoscopic mesh vaporization. There are very few published studies detailing endoscopic management. This unique case describes how repeated endoscopic mesh vaporization may be required as mesh extrusion may progress. Methods: A 71-year old female with a history of pelvic organ prolapse managed with an anterior transvaginal mesh kit presented years later with persistent urgency incontinence and recurrent acute cystitis. Cystoscopy eventually revealed bladder calculi adherent to extruded mesh. The stones and extruded mesh were vaporized using the Holmium laser on three occasions over 3 years. Results: Our approach offered a minimally invasive technique with short recovery, no use of a catheter post-operatively and maintained original prolapse repair; however, these patients may be at risk of mesh extrusion recurrence. Conclusion: Bladder extrusion of transvaginal pelvic organ prolapse kit mesh is thankfully a rare complication. With no current consensus for treatment of bladder mesh extrusion, the decision to perform complete mesh excision versus endoscopic treatment should be based on the degree and location of the extrusion, the risk of major complications, mesh extrusion recurrence and the patient’s desired outcomes, including recovery time and risk for prolapse recurrence. Endoscopic vaporization of extruded pelvic organ prolapse mesh likely has a higher recurrence rate than vaginal or abdominal excision. The risks and benefits are important to discuss during counseling and informed consent in these difficult cases. Level of evidence: 4
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Affiliation(s)
- Ariel J. Dunn
- Division of Urogynecology, Department of Obstetrics and Gynecology, Walter Reed National Military Medical Center, United States of America
| | - Katherine L. Dengler
- Division of Urogynecology, Department of Obstetrics and Gynecology, Walter Reed National Military Medical Center, United States of America
| | - Daniel D. Gruber
- Division of Urogynecology, Department of Obstetrics and Gynecology, Walter Reed National Military Medical Center, United States of America
| | - David J. Osborn
- Department of Urology, Walter Reed National Military Medical Center, United States of America
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Giarenis I, Anding R, Chermansky C, Greenwell T, Cardozo L, Harding C. Do we have adequate data to construct a valid algorithm for management of synthetic midurethral sling complications? ICI-RS 2019. Neurourol Urodyn 2020; 39 Suppl 3:S122-S131. [PMID: 32022954 DOI: 10.1002/nau.24299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 01/14/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND Synthetic midurethral sling (MUS) procedures, purported for the last two decades as the gold standard surgical treatment for stress urinary incontinence, have been in creasingly scrutinized in recent years with regard to the rate and severity of complications. METHODS During the International Consultation on Incontinence Research Society meeting held in Bristol, UK, in 2019, a multidisciplinary panel held a think tank and discussed the contemporary evidence pertaining to the classification, investigation, and treatment of MUS complications. RESULTS The current classification system of mesh-related complications was discussed, and shortcomings were identified. The lack of a standardized clinical pathway was noted, and the value of clinical investigations and surgical treatments was difficult to fully evaluate. The paucity of high-level evidence was a common factor in all discussions, and the difficulties with setting up relevant randomized-controlled trials were highlighted. CONCLUSIONS The outcome of the think-tank discussions is summarized with a set of recommendations designed to stimulate future research.
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Affiliation(s)
- Ilias Giarenis
- Department of Urogynaecology, Norfolk and Norwich Hospital, Norwich, UK
| | - Ralf Anding
- Department of Neurourology/Urology, Bonn and Neurological Rehabilitation Center "Godeshöhe" e.V., University Clinic, Friedrich Wilhelms University, Bonn, Germany
| | - Christopher Chermansky
- Department of Female Pelvic Medicine and Reconstructive Urology, UPMC Magee-Womens Hospital, Pittsburgh, Pennsylvania
| | - Tamsin Greenwell
- Department of Urology, University College London Hospital, London, UK
| | - Linda Cardozo
- Department of Urogynaecology, King's College Hospital, London, UK
| | - Christopher Harding
- Department of Urology, Freeman Hospital, Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, UK
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Karim SS, Pietropaolo A, Skolarikos A, Aboumarzouk O, Kallidonis P, Tailly T, de Coninck V, Keller EX, Somani BK. Role of endoscopic management in synthetic sling/mesh erosion following previous incontinence surgery: a systematic review from European Association of Urologists Young Academic Urologists (YAU) and Uro-technology (ESUT) groups. Int Urogynecol J 2019; 31:45-53. [PMID: 31468095 PMCID: PMC6949195 DOI: 10.1007/s00192-019-04087-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 08/08/2019] [Indexed: 11/05/2022]
Abstract
Introduction and hypothesis Foreign body (FB) erosion is now recognized as a major long-term complication following previous incontinence surgery. The aim of our systematic review was to ascertain the outcomes of endoscopic management in synthetic sling/mesh erosion following previous gynaecological surgery. Methods A systematic review in line with PRISMA and Cochrane guidelines was conducted for all English language articles between 1996 and December 2018 for all articles reporting on endoscopic surgical management for eroded FB following previous sling/mesh procedure for incontinence. Results Our search produced 931 articles of which 20 articles (198 patients) were included in our review; 149 (75%) had tension-free vaginal tapes (TVT) or tension-free obturator tapes (TOT) as their initial procedure. The site of mesh erosion was the bladder in 134 patients (68%) of which 12 (6%) were in the bladder neck. Urethral mesh erosion was seen in 63 patients (32%) across all studies. The treatment of eroded mesh was by laser and endoscopic excision using an electrode loop or laparoscopic scissors in 108 (55%) and 90 (45%) patients respectively. The initial/final success rate with laser and endoscopic excision was 67%/92% and 80%/98% respectively. The overall complication rates were 24% and 28% in laser and endoscopic groups respectively of which 21% in each group were stress urinary incontinence. Conclusions Endoscopic management of FB erosion is an effective minimally invasive technique with good outcomes and minimal morbidity. Management with the use of holmium laser is gaining momentum and could be attempted before open surgical removal. There is a need for comparative data between open surgical excision and endoscopic excision to help better describe the patient’s most likely to benefit from the endoscopic technique.
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Affiliation(s)
| | | | - Andreas Skolarikos
- 2nd Department of Urology, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Omar Aboumarzouk
- Department of Urology, Queen Elizabeth University Hospital, Glasgow, UK
| | | | | | | | - Etienne Xavier Keller
- Department of Urolog, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Bhaskar Kumar Somani
- University Hospital Southampton NHS Trust, Southampton, UK. .,Department of Urology, University Hospital Southampton NHS Trust, Southampton, SO16 6YD, UK.
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Wang C, Zimmern PE, Lemack G. Long-term results of transurethral endoscopic excision using the holmium laser for urethral perforation of synthetic slings. Low Urin Tract Symptoms 2018; 11:O103-O110. [PMID: 29956499 DOI: 10.1111/luts.12226] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 04/12/2018] [Accepted: 04/23/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study reports on the long-term results of transurethral endoscopic excision using the Holmium laser (TEEH) for large urethral perforation (UP; defined as involving one-quarter or more of the urethral circumference) from synthetic slings. METHODS Charts of women treated with TEEH for large UP were reviewed. TEEH was performed using a 365-μm laser fiber passed inside an open-ended ureteral catheter positioned in a holmium laser enucleation of the prostate (HoLEP) sheath to stabilize the laser fiber. Data extracted included patient demographics, clinical presentations, surgical details, postoperative functional outcomes and complications, and any secondary repairs. RESULTS From 2011 to 2016, 12 women underwent TEEH. The mean interval between sling placement and first TEEH was 47 months (range 10-161 months). The types of slings included transvaginal tape (n = 2), transobturator tape (n = 4), mini-invasive (n = 4), and Solyx (1), or were not specified (n = 1). The mean number of TEEH procedures was 1.6 (range 1-3), and the mean length of initial treatment was 40 min (range 15-79 min), with subsequent treatments <30 min. Mean follow-up time was 43 months (range 14-70). Resolution of UP by TEEH alone was achieved in 6 patients, with 2 requiring multiple TEEH. Six patients underwent secondary vaginal mesh sling excision alone or with an associated repair including 2 small distal urethrovaginal fistulas. CONCLUSION TEEH is a minimally invasive procedure that can avoid a more complex initial urethral reconstruction and should be considered for treating large UP. Secondary repairs for residual small UP or associated lower urinary tract symptomatology may be necessary and patients should be counseled accordingly.
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Affiliation(s)
- Connie Wang
- The University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - Gary Lemack
- The University of Texas Southwestern Medical Center, Dallas, Texas
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