'What research was carried out on this vaginal mesh?' Health-related concerns in women following mesh-augmented prolapse surgery: a thematic analysis

OBJECTIVE

To understand health-related issues in women following mesh-augmented prolapse surgery.

DESIGN

Inductive thematic analysis of free-text comments from participants in a cross-sectional study of laparoscopic mesh sacrohysteropexy.

SETTING

Tertiary urogynaecology centres, United Kingdom.

POPULATION

Women who underwent laparoscopic mesh sacrohysteropexy by surgeons based at two tertiary urogynaecology centres between 2010 and 2018.

METHODS

A total of 1766 potential participants were contacted by post and invited to complete paper, online or telephone questionnaires containing a free-text comments section. Of 1121 participants (response proportion 63.5%), 752 (67.1%) provided such comments. These were analysed with a six-stage inductive thematic analysis, using NVivo 11® software.

MAIN OUTCOME MEASURES

Themes developed from free-text comments.

RESULTS

Following familiarisation, 29 codes and 189 sub-codes were identified. These defined six themes: pelvic floor symptoms, health status, treatment success, mesh, pain and care received. The majority of comments centred on the first of these six themes. There were concerns about mesh use and a desire for more information. A range of pain symptoms were mentioned, often associated with pelvic floor symptoms, prolapse surgery or mesh.

CONCLUSIONS

Despite the mesh controversy, pelvic floor symptoms and their impact on quality of life remain the principle concern of women following mesh-augmented prolapse surgery. There is a need for quality, accessible and evidence-based information sources for those women with concerns, and for those considering such surgery in the future, particularly regarding mesh safety and postoperative recovery. The relationships between pain, prolapse, mesh and pelvic floor surgery require further study.

TWEETABLE ABSTRACT

Following mesh-augmented prolapse surgery, pelvic floor symptoms remain women's main focus; pain deserves further research.

Obstructive mullerian anomalies and modern laparoscopic management

STUDY OBJECTIVE

Congenital uterine anomalies are common, although the majority are asymptomatic. When an obstructed system exists, women may present with abdominal pain, or dysmenorrhea. Removal of the obstructed horn may be required in the symptomatic patient. In the past, surgical treatment necessitated a laparotomy.

DESIGN

After preoperative diagnosis and planning using magnetic resonance imaging, laparoscopic removal of the obstructed uterine horn and tube was performed. Morcellation of tissue was used to permit removal through a 15mm port.

SETTING

A central London tertiary referral teaching hospital.

PARTICIPANTS

15 women aged between 13 and 41.

INTERVENTIONS

Between 1999 and 2005, all women underwent laparoscopic removal of the obstructed uterine horn and tube.

MAIN OUTCOME MEASURES

Recovery, hospital stay, length of operation.

RESULTS

All women recovered well, with an operation time of 80 to 300 minutes and an average hospital stay of 5 days.

CONCLUSIONS

A laparoscopic approach is a safe and appropriate technique for the removal of an obstructed uterine horn.

Laparoscopic treatment of endometriosis in teenagers

OBJECTIVES

To determine the frequency and severity of endometriosis in adolescent and teenager girls with chronic pelvic pain (CPP) who fail to respond to medical treatment and to evaluate the outcome of radical laparoscopic surgery for severe endometriosis.

DESIGN

Retrospective review of case records of all girls under the age of 21 years who underwent diagnostic and/or operative laparoscopy for CPP unresponsive to medical treatment between January 2001 and December 2003. The operative findings and the response to surgery were retrospectively reviewed.

RESULTS

Thirty-one girls were referred. No pelvic abnormalities were detected in 11 patients (35.5%). Endometriosis was detected in 11 (35.5%). Six had severe endometriosis. Other diagnoses included: non-functional non-endometriotic ovarian cyst (4 patients), functional ovarian cyst (1 patient), hydrosalpinx (bilateral, 1 patient; unilateral, 1 patient) and obstructed uterine horn (2 patients). Of those with severe disease all six were treated laparoscopically without complications. Five were rendered pain free and one had an improvement in symptoms.

CONCLUSIONS

Endometriosis can occur in adolescent and teenager girls. Laparoscopy should be carried out in all adolescents and teenagers with CPP unresponsive to medical treatment. This the first study reporting the outcome of radical excision treatment for severe endometriosis in this age group and early results are encouraging.

Laparoscopic vaginoplasty: alternative techniques in vaginal reconstruction

Construction of a neovagina is the next step for women with an absent vagina who have failed vaginal dilator therapy. Traditional operative techniques such as skin grafting or intestinal substitution have major disadvantages including prolonged recovery time and significant scarring. Laparoscopic vaginoplasty is performed widely throughout Europe but has not been available in the UK until now. We report on five women who underwent laparoscopic vaginoplasty. Three women underwent a laparoscopic Vecchietti procedure and two underwent a laparoscopic Davydov procedure. Details were recorded on preoperative features, perioperative problems and early postoperative outcome. Laparoscopic vaginoplasty is a safe treatment for vaginal agenesis, and short-term results are encouraging.