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Bretschneider CE, Myers ER, Geller EJ, Kenton KS, Henley BR, Matthews CA. Long-Term Mesh Exposure 5 Years Following Minimally Invasive Total Hysterectomy and Sacrocolpopexy. Int Urogynecol J 2024; 35:901-907. [PMID: 38530401 PMCID: PMC11052764 DOI: 10.1007/s00192-024-05769-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 02/14/2024] [Indexed: 03/28/2024]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to assess long-term mesh complications following total hysterectomy and sacrocolpopexy. METHODS In this second extension study, women from a multicenter randomized trial were followed for more than 36 months after surgery. Owing to COVID-19, participants were assessed through either in-person visits or telephone questionnaires. The primary outcome was the incidence of permanent suture or mesh exposure. Secondary outcomes included surgical success and late adverse outcomes. RESULTS Out of the 200 initially enrolled participants, 82 women took part in this second extension study. Among them, 46 were in the permanent suture group, and 36 in the delayed absorbable group. The mean follow-up duration was 5.3 years, with the cumulative mesh or suture exposure of 9.9%, involving 18 cases, of which 4 were incident cases. Surgical success after more than 5 years stood at 95%, with few experiencing bothersome bulge symptoms or requiring retreatment. No serious adverse events occurred, including mesh erosion into the bladder or bowel. The most common adverse events were vaginal pain, bleeding, dyspareunia, and stress urinary incontinence, with no significant differences between suture types. CONCLUSION The study found that mesh exposure risk gradually increased over time, reaching nearly 10% after more than 5 years post-surgery, regardless of suture type. However, surgical success remained high, and no delayed serious adverse events were reported.
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Affiliation(s)
- C Emi Bretschneider
- Division of Female Pelvic Medicine and Reconstructive Surgery, Northwestern University, Chicago, IL, USA
| | - Erinn R Myers
- Division of Female Pelvic Medicine and Reconstructive Surgery, Atrium Health, Charlotte, NC, USA
| | - Elizabeth J Geller
- Division of Female Pelvic Medicine and Reconstructive Surgery, University of North Carolina, Chapel Hill, NC, USA
| | - Kimberly S Kenton
- Division of Female Pelvic Medicine and Reconstructive Surgery, University of Chicago, Chicago, IL, USA
| | - Barbara R Henley
- Division of Female Pelvic Medicine and Reconstructive Surgery, August University Medical Center, Augusta, GA, USA
| | - Catherine A Matthews
- Division of Female Pelvic Medicine and Reconstructive Surgery, Wake Forest University, Winston Salem, NC, USA.
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Leong KA, Husk KE. Stone accumulation overlying vaginal mesh exposure: A case report. World J Obstet Gynecol 2023; 12:28-32. [DOI: 10.5317/wjog.v12.i3.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 04/10/2023] [Accepted: 04/24/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Vaginal stones are rare with current literature limited to case reports. Vaginal stones are classified as primary or secondary stones. Primary stones form in the vagina when there is urinary stasis. Secondary stones form in the presence of a vaginal foreign body that acts as a nidus for the deposition of urinary salts. Foreign bodies, such as surgical mesh, make vaginal stone formation more likely, particularly in patients with urinary incontinence and conditions that predispose them to urinary calculi formation.
CASE SUMMARY A 71-year-old female with a history of sacrocolpopexy, hyperaldosteronism, and urgency urinary incontinence presented with vaginal stone accumulation overlying two areas of vaginal sacrocolpopexy mesh exposure. The vaginal stones were initially removed to permit examination, but the stones reaccumulated at the site of the exposed mesh, later requiring definitive surgical management.
CONCLUSION Patients with vaginal mesh exposure and conditions that predispose them to kidney stones are not ideal candidates for expectant management of mesh exposure, particularly if they have coexisting urinary incontinence. These individuals should be counseled about possible vaginal stone accumulation, and surgical management should be considered.
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Affiliation(s)
- Karissa A Leong
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Albany Medical Center, Albany, NY 12208, United States
| | - Katherine E Husk
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Albany Medical Center, Albany, NY 12208, United States
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Brennan LC, Epp A. Delayed mesh erosion 11 years post Ajust™ transobturator tape. Int Urogynecol J 2023:10.1007/s00192-023-05524-2. [PMID: 37071136 DOI: 10.1007/s00192-023-05524-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 03/20/2023] [Indexed: 04/19/2023]
Affiliation(s)
- Lacey C Brennan
- Department of Obstetrics and Gynecology, University of Saskatchewan, Room 4544, Royal University Hospital, 103 Hospital Drive, Saskatoon, Saskatchewan, S7N 0W8, Canada.
| | - Annette Epp
- Department of Obstetrics and Gynecology, University of Saskatchewan, Room 4544, Royal University Hospital, 103 Hospital Drive, Saskatoon, Saskatchewan, S7N 0W8, Canada
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Shawer S, Boodhoo V, Licari O, Pringle S, Tyagi V, Revicky V, Guerrero K. Total trans-obturator tape (TOT) removal; a case series including pain and urinary continence outcomes. Int Urogynecol J 2022; 34:1017-1023. [PMID: 35881175 PMCID: PMC9314537 DOI: 10.1007/s00192-022-05299-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 06/28/2022] [Indexed: 11/26/2022]
Abstract
Introduction and hypothesis For many years, mid-urethral mesh tape (MUT) was the gold-standard procedure for management of stress urinary incontinence (SUI). However, significant concerns were raised over its safety. We present a case series of total trans-obturator tape (TOT) removals, performed in a tertiary unit over a 3-year period. We aim to evaluate improvement of pain and change in urinary continence symptoms following mesh explantation. Methods This is a retrospective case series of the outcomes of total TOT removal. Primary outcome is the change in pain scores following total removal, assessed preoperatively, at discharge and follow-up. Secondary outcomes were perioperative complications, including return to theatre, re-admission rates and incidence of worsening SUI and overactive bladder symptoms (OAB) postoperatively. Statistical analyses were performed using SPSS 27.0 package (IBM, Chicago, IL) and the GraphPad Prism 9 statistical packages. Results Nineteen women were identified. Mean age was 52 years and mean BMI was 31. Indications for mesh removal were: chronic pain (95%), vaginal exposure (37%) and pelvic sepsis (5%). No patients had return to theatre. Median intraoperative blood loss was 200 ml (interquartile range [IQR]: 150–288). Mean length of mesh excised was 22 cm. Mean postoperative hospital stay was 2 days. At follow-up, most patients (72%) reported “improvement” of their mesh-related pain at follow-up, while 6% reported “worsening” of pain. Eighty-three per cent of patients reported worsening SUI, and 50% reported worsening OAB symptoms. Conclusions In the absence of sepsis, significant intraoperative complications are rare during total TOT removals. While 72% of patients reported improvement of their mesh-related pain, 6% still reported worsening pain after total mesh excision.
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Affiliation(s)
- Sami Shawer
- Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, 1345 Govan road, Glasgow, G51 4TF, UK.
| | - Vijna Boodhoo
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Oliver Licari
- Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, 1345 Govan road, Glasgow, G51 4TF, UK
| | - Stewart Pringle
- Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, 1345 Govan road, Glasgow, G51 4TF, UK
| | - Veenu Tyagi
- Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, 1345 Govan road, Glasgow, G51 4TF, UK
| | - Vladimir Revicky
- Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, 1345 Govan road, Glasgow, G51 4TF, UK
| | - Karen Guerrero
- Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, 1345 Govan road, Glasgow, G51 4TF, UK
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Shi C, Zhao Y, Hu Q, Gong R, Yin Y, Xia Z. Clinical analysis of pain after transvaginal mesh surgery in patients with pelvic organ prolapse. BMC Womens Health 2021; 21:46. [PMID: 33516228 PMCID: PMC7847570 DOI: 10.1186/s12905-021-01192-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 01/21/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The purpose of this study was to investigate the relevant factors of pain after transvaginal mesh (TVM) surgery for the treatment of pelvic organ prolapse and to analyse the management and relief of the pain. METHODS A multicentre retrospective study of a clinical database of patients who underwent TVM surgery was conducted, and pain related aspects were analysed. RESULTS A total of 1855 patients were included in the study. We divided the patients into two groups: pain-free (1805 patients) and pain (50 patients) group. The incidence of pain after TVM surgery was 2.70%, with a median occurrence time of 7.5 months. Pain mainly involved the vagina, perineum, buttocks, groin, inner thighs, and lower abdomen. Excessive intraoperative blood loss (OR = 1.284, 95% CI 0.868-2.401) and postoperative anatomic failure (OR = 1.577, 95% CI 0.952-3.104) were analysed as risk factors with statistical significance. Mesh exposure rate in the pain group was 38%, showing a significant difference between the groups (P < 0.01). Forty patients underwent non-surgical treatment, with a relief rate of 40.0%, 33 patients received surgical treatment, 15 underwent partial mesh removal, and 18 underwent complete mesh removal, with a relief rate of 84.8%. The total relief rate was 88% within all 50 patients suffering from pain. CONCLUSIONS Excessive intraoperative bleeding and unsatisfactory postoperative anatomic outcomes can increase the risk of postoperative pain; mesh exposure is also associated with the pain. Most patients can get pain relief with proper management, more than half of whom may need mesh removal with differing approach.
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Affiliation(s)
- Chang Shi
- Department of Gynecology and Obstetrics, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang, 110004, Liaoning, China
| | - Ying Zhao
- Department of Gynecology and Obstetrics, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang, 110004, Liaoning, China
| | - Qing Hu
- Department of Gynecology and Obstetrics, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang, 110004, Liaoning, China
| | - Runqi Gong
- Department of Gynecology and Obstetrics, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang, 110004, Liaoning, China
| | - Yitong Yin
- Department of Gynecology and Obstetrics, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang, 110004, Liaoning, China
| | - Zhijun Xia
- Department of Gynecology and Obstetrics, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang, 110004, Liaoning, China.
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Angelova N, Taylor L, McKee L, Fearns N, Mitchell T. User testing a patient information resource about potential complications of vaginally inserted synthetic mesh. BMC Womens Health 2021; 21:35. [PMID: 33494737 PMCID: PMC7831188 DOI: 10.1186/s12905-020-01166-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 12/29/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Vaginal mesh implants are medical devices used in a number of operations to treat stress urinary incontinence and pelvic organ prolapse. Although many of these operations have delivered good outcomes, some women have experienced serious complications that have profoundly affected their quality of life. To ensure that evolving patient information is up-to-date, accurate and appropriate, the Transvaginal Mesh Oversight Group 'user-tested' a newly developed Scottish patient resource, the first to focus exclusively on the issue of complications. The aim of this research was to gather feedback on usability, content, language and presentation to inform the development of the resource from a user perspective. METHODS The experience of using the patient resource was captured through semi-structured interviews that followed a 'think-aloud' protocol. The interviewer observed each participant as they went through the resource, asking questions and making field notes. Participants' comments were then categorised using a validated model of user experience and subsequently analysed thematically. RESULTS Thirteen people participated in the user testing interviews, including women with lived experience of mesh implants (n = 7), a convenience sample of staff working for Healthcare Improvement Scotland (n = 5) and a patient's carer (n = 1). The majority of participants considered the resource as clear and helpful. Respondents reported that some presentational aspects promoted usability and understandability, including the use of a font that is easy to read, bullet lists, coloured headings and simple language. Barriers included the reliance on some technical language and an explicit anatomical diagram. Participants endorsed the valuable role of health professionals as co-mediators of patient information. CONCLUSIONS The findings illustrate the value of undertaking in-depth user-testing for patient information resources before their dissemination. The study highlighted how the direct guidance or navigation of a patient information resource by a health professional could increase its salience and accuracy of interpretation by patients, their families and carers. These insights may also be useful to other developers in improving patient information.
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Affiliation(s)
- Nikolina Angelova
- Health Services Researcher, Healthcare Improvement Scotland, Gyle Square, 1 South Gyle Crescent, Edinburgh, EH12 9EB, Scotland, UK.
| | - Louise Taylor
- Information Analyst, Healthcare Improvement Scotland, Gyle Square, 1 South Gyle Crescent, Edinburgh, EH12 9EB, Scotland, UK
| | - Lorna McKee
- Emeritus Professor of Management and Health Services Research, University of Aberdeen, 3rd Floor, Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD, Scotland, UK
| | - Naomi Fearns
- Health Services Researcher, Healthcare Improvement Scotland, Gyle Square, 1 South Gyle Crescent, Edinburgh, EH12 9EB, Scotland, UK
| | - Tracey Mitchell
- Healthcare Improvement Scotland, Delta House, 50 West Nile Street, Glasgow, G1 2NP, Scotland, UK
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Chandrasinghe P, De Silva A, Welivita A, Deen K. Complete migration of a composite mesh into small bowel incidentally found during laparotomy for colectomy in an asymptomatic patient: a case report. J Med Case Rep 2020; 14:207. [PMID: 33126917 PMCID: PMC7602325 DOI: 10.1186/s13256-020-02540-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 09/21/2020] [Indexed: 11/29/2022] Open
Abstract
Background Composite meshes are used for incisional hernia repair because they enable intraperitoneal mesh placement due to their dorsal surface, which is made of inert material. We report, for the first time, to our knowledge, a case of composite mesh migration detected incidentally during a laparotomy for colon cancer in an asymptomatic patient. Case presentation Our patient was a 71-year-old South Asian man who underwent ventral mesh repair following a postoperative complication after right hemicolectomy for colon cancer. The patient was diagnosed with a metachronous sigmoid cancer 5 years later, for which he underwent laparotomy. During laparotomy, a migrated mesh was incidentally found and extracted from his proximal ileum without any evidence of abscess or fistula formation. Conclusion To our knowledge, this is the first report of an incidentally found migrated composite mesh from a bowel lumen in an asymptomatic patient.
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Affiliation(s)
- Pramodh Chandrasinghe
- Department of Surgery, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.
| | - Asantha De Silva
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
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Ceci F, D'Amore L, Grimaldi MR, Bambi L, Annesi E, Negro P, Gossetti F. Re-do surgery after prosthetic abdominal wall repair: intraoperative findings of mesh-related complications. Hernia 2021; 25:435-40. [PMID: 32495044 DOI: 10.1007/s10029-020-02225-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 05/20/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Mesh repair is one of the most popular technique for the treatment of abdominal wall hernias, resulting in lower recurrence rates. However, it is associated with a high risk of mesh-related complications. The aim of the present study is to assess the impact of biomaterials on the intra-abdominal organs, in terms of adhesions and visceral complications, in a series of patients undergoing re-do surgery at our abdominal wall unit. MATERIALS AND METHODS We reviewed the clinical records of 301 patients who undergone laparotomy between June 2008 and May 2018, selecting 67 patients with one or more previous prosthetic abdominal wall repair (AWR). RESULTS The average number of previous repairs was 1.6 with a mean time interval of 66 months from the last repair. Clinical presentation included hernia recurrence (69%), mesh infection (26%), infection and recurrence (10%), and fistula (1%). Adhesions were intraoperatively observed in all patients, except for eight cases. Mesh was completely removed in 43 patients, partially in four. Postoperative complications were observed in 39% of cases, including wound dehiscence, hematoma, seroma, and mesh infection. CONCLUSIONS Long-term implant results in abdominal wall repair and are not completely known, and literature is still lacking on this topic. Re-do surgery for subsequent pathological events may represent a way to increase our knowledge.
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Orhan A, Rantell A, Ozerkan K, Kasapoglu I, Ocakoglu G, Aslan K, Mert SN, Uncu G, Cardozo L. Social media awareness among non-urogynecologists regarding the current mesh discussions in urogynecology: a survey study. Int Urogynecol J 2020; 31:1231-1243. [PMID: 32067058 DOI: 10.1007/s00192-020-04242-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 01/23/2020] [Indexed: 01/24/2023]
Abstract
INTRODUCTION AND HYPOTHESIS There has been a great deal of discussion about mesh complications in urogynecology in recent years. However, awareness of other doctors who are not urogynecologists is unknown. This study was aimed at determining the level of awareness of mesh discussions among medical doctors whose specialty is not urology or gynecology. METHODS A survey study was administered, and all medical doctors, except gynecologists and urologists, were invited. Respondent doctors were classified into four groups: King's College Hospital (KCH), UK; Uludag University Hospital (UUH), Turkey; the United States (USA); and the world (WORLD). The primary outcome was the awareness of mesh discussion in urogynecology, and the secondary outcome was the social media awareness of the mesh discussion. RESULTS 1231 doctors responded to the survey. The awareness of the current mesh problems among the respondent doctors was 15.8% in KCH, 15.4% in UUH, 26.9% in the USA, and 16.2% in WORLD. The social media awareness about mesh problems was 20.8% in KCH, 20.3% in UUH, 32.8% in the USA, and 20.6% in WORLD. Although there were no differences among three of the groups with regard to primary and secondary outcomes, the USA group score was statistically significantly higher than the others. CONCLUSIONS Social media can influence doctors' thinking on controversial academic issues. In this survey study, non-urogynecologist doctors in the USA cohort have higher awareness levels and a higher social media awareness level than other groups.
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Affiliation(s)
- Adnan Orhan
- Department of Obstetrics and Gynecology, Urogynecology and Pelvic Reconstructive Surgery Unit, Uludag University Hospital, Gorukle Campus, 16039, Bursa, Turkey.
| | - Angie Rantell
- Department of Urogynecology, King's College Hospital, London, UK
| | - Kemal Ozerkan
- Department of Obstetrics and Gynecology, Urogynecology and Pelvic Reconstructive Surgery Unit, Uludag University Hospital, Gorukle Campus, 16039, Bursa, Turkey
| | - Isil Kasapoglu
- Department of Obstetrics and Gynecology, Urogynecology and Pelvic Reconstructive Surgery Unit, Uludag University Hospital, Gorukle Campus, 16039, Bursa, Turkey
| | - Gokhan Ocakoglu
- Department of Biostatistics, Uludag University Hospital, Bursa, Turkey
| | - Kiper Aslan
- Department of Obstetrics and Gynecology, Urogynecology and Pelvic Reconstructive Surgery Unit, Uludag University Hospital, Gorukle Campus, 16039, Bursa, Turkey
| | - Sevde Nur Mert
- Department of Obstetrics and Gynecology, Urogynecology and Pelvic Reconstructive Surgery Unit, Uludag University Hospital, Gorukle Campus, 16039, Bursa, Turkey
| | - Gurkan Uncu
- Department of Obstetrics and Gynecology, Urogynecology and Pelvic Reconstructive Surgery Unit, Uludag University Hospital, Gorukle Campus, 16039, Bursa, Turkey
| | - Linda Cardozo
- Department of Urogynecology, King's College Hospital, London, UK
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Mahoney C, Hindle A, Rajashanker B, Kearney R. MR scan evaluation of pelvic organ prolapse mesh complications and agreement with intra-operative findings. Int Urogynecol J 2019; 31:1559-1566. [PMID: 31853599 PMCID: PMC7363669 DOI: 10.1007/s00192-019-04182-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 11/10/2019] [Indexed: 11/27/2022]
Abstract
Introduction An increasing number of women are presenting with symptoms after the placement of mesh implants for prolapse which may be attributable to a mesh implant complication. MRI imaging can be used to evaluate abdominally placed mesh but there is no published research evaluating the use of MRI in this group of women. The objective of our study was to report our experience as a tertiary centre in evaluating abdominal mesh with MR imaging and the agreement of MR reports with surgical findings. Study design A retrospective observational cohort study (Canadian Task Force classification II-2) of all women referred to our tertiary unit who underwent an MR scan for investigation of symptoms of mesh complication following an abdominally placed mesh implant between June 2006 and September 2018 was performed. The reports of MR images were compared with the findings at surgery. Results MR scan was performed in 87 with suspected mesh complications. MR scan detected mesh failure in 42.1% of women (37/87), infection in 12.6% (11/87), compression in 2.3% (2/87), exposure in 12.6% (11/88), bowel extrusion in 2.3% (2/87) and inflammation in 11.5% (10/87). Agreement between MR scan report and surgical diagnosis was almost perfect for mesh failure, infection and compression, whilst agreement was only moderate for mesh erosion and signs of inflammation (failure κ = 0.97, infection κ = 0.94, compression κ = 1.0, exposure κ = 0.58 and inflammation κ = 0.24). Conclusion These data provide information on the role of MR imaging in the investigation of women presenting with suspected intra-abdominal POP mesh complications including recurrence.
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Affiliation(s)
- Charlotte Mahoney
- The Warrell Unit, St Mary's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Oxford Road, Manchester, M13 9WL, UK
| | - Adam Hindle
- Fairfield General Hospital, Pennine Acute NHS Trust, Bury, BL9 7TD, UK
| | - Balashanmugam Rajashanker
- Department of Radiology, Manchester Royal Infirmary, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, M13 9WL, UK
| | - Rohna Kearney
- The Warrell Unit, St Mary's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Oxford Road, Manchester, M13 9WL, UK.
- Institute of Human Development, Faculty of Medical & Human Sciences, University of Manchester, Manchester, UK.
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Siddharth A, Cartwright R, Jackson S, Price N. Laparoscopic complete sacrocolpopexy mesh removal for right-sided gluteal pain and recurrent mesh erosion. Int Urogynecol J 2019; 31:411-413. [PMID: 31478076 DOI: 10.1007/s00192-019-04088-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 08/08/2019] [Indexed: 11/26/2022]
Abstract
AIM OF VIDEO The aim was to demonstrate laparoscopic complete excision of sacrocolpopexy mesh from a 65-year-old woman who had presented with delayed onset of persistent right-sided gluteal pain. METHOD The patient was referred to our unit, having undergone a laparoscopic sacrocolpopexy for vault prolapse 7 years earlier, with a type 1 polypropylene mesh. Four years after the primary surgery, she first noticed symptoms of spontaneous vaginal pain together with deep dyspareunia, and right-sided gluteal pain. Clinical examination revealed mesh erosion at the vaginal vault. This was managed at her local hospital, with excision of the small exposed portion of the mesh and over sewing, from a vaginal approach. She continued to be symptomatic following this procedure. When her symptoms still failed to improve 3 years later, a tertiary referral was made to our unit. At laparoscopy, minimal adhesions between the bowel and the mesh were noted and divided. After carefully dissecting the right ureter and reflecting the bladder, the entire sacrocolpopexy mesh was removed with its ProTack fasteners. The entire specimen was retrieved in one piece through the open vault and the vagina was sutured with 2.0 <monocryl laparoscopically. Surgical steps begin with laparoscopic survey of the anatomy. Adhesions need to be released carefully, after developing proper surgical planes. On follow-up in clinic 12 weeks later, there was complete resolution of her symptoms, with minimal vault descent. CONCLUSION This video demonstrates the steps needed to undertake complete laparoscopic sacrocolpopexy mesh excision, which should be feasible for skilled laparoscopists. This approach has advantages over the open approach, with good access and visualisation of the entire course of the mesh, and more rapid recovery for the patient.
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Affiliation(s)
- Aditi Siddharth
- John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU, UK
| | - Rufus Cartwright
- John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU, UK
| | - Simon Jackson
- John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU, UK
| | - Natalia Price
- John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU, UK.
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Ugianskiene A, Davila GW, Su TH. FIGO review of statements on use of synthetic mesh for pelvic organ prolapse and stress urinary incontinence. Int J Gynaecol Obstet 2019; 147:147-155. [PMID: 31353463 DOI: 10.1002/ijgo.12932] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 05/21/2019] [Accepted: 07/26/2019] [Indexed: 11/07/2022]
Abstract
The use of synthetic mesh implantation for the surgical management of pelvic organ prolapse (POP) and stress urinary incontinence (SUI) has grown in popularity since mesh was marketed for widespread use in the early 1990s. As mesh usage has expanded, patterns of previously unexpected complications have become apparent. In the United States and other countries, the increase in reported outcomes (both positive and negative) has led to the initiation of medico-legal actions by patients reporting negative effects of the implanted mesh. As a result, several national and professional societies have convened expert panels to publish summaries of reported outcomes and provide clinical recommendations regarding mesh use. Despite their recommendations and further dissemination of the potential complications reported after urogynecologic mesh use, the popularity of mesh use for POP and SUI has continued to expand, with apparent geographic and national patterns. As the largest global association focusing on women's health, FIGO, via its Urogynecology and Pelvic Floor Committee, has reviewed published national recommendations regarding the use of mesh, and has summarized them for the FIGO membership to help disseminate important recommendations to surgeons who may not be aware of the existence and content of these recommendations.
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Mangır N, Hillary CJ, Chapple CR, MacNeil S. Oestradiol-releasing Biodegradable Mesh Stimulates Collagen Production and Angiogenesis: An Approach to Improving Biomaterial Integration in Pelvic Floor Repair. Eur Urol Focus 2017; 5:280-289. [PMID: 28753895 DOI: 10.1016/j.euf.2017.05.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 05/15/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Polypropylene meshes cause severe complications in some patients. Materials that are biomechanically compatible and can better integrate into host tissues are urgently needed. OBJECTIVE To design an oestradiol-releasing electrospun poly-l-lactic acid (PLA) mesh and evaluate its ability to stimulate new extracellular matrix and new blood vessel formation. DESIGN, SETTING, AND PARTICIPANTS Human adipose derived mesenchymal cells (ADMSC) were isolated from fat. PLA meshes with micro- to nano-sized fibres containing 1%, 5%, and 10% oestradiol were constructed and used for in vitro and in vivo experiments. INTERVENTION The angiogenic potential of the fibrous meshes was evaluated using an in vivo chorioallantoic membrane and an in vitro chick aortic arch assays. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Oestradiol release was measured fluorometrically. The effect of fibrous meshes on proliferation and extracellular matrix (ECM) production of ADMSC was assessed using immunohistology. Mechanical properties were tested using a tensiometer. RESULTS AND LIMITATIONS The ultrastructure of the mesh was not affected by the inclusion of oestradiol and mechanical properties were only slightly modified. Oestradiol was released from PLA meshes over a 5-mo period. ADMSCs cultured on oestradiol-releasing PLA meshes produced more ECM involving collagen I, collagen III, and elastin. Oestradiol-releasing meshes doubled new blood vessel formation in the chorioallantoic membrane assay (p=0.001) and outgrowth of pro-angiogenic cells in the aortic arch assay (p=0.001). Further studies in longer-term animal models are required to confirm these results. CONCLUSIONS Oestradiol-releasing PLA meshes increase ECM production and stimulate angiogenesis. As such, they are promising candidate materials to be used in pelvic floor repair and to improve the initial healing phase of a repair material following implantation. PATIENT SUMMARY In this study, we designed a tissue engineered material to be used to support weakened pelvic floor tissues in women to avoid the complications associated with current surgical mesh. Our results showed that this material can stimulate new blood vessel formation in simple chick assays and tissue production in vitro. Both properties should help with the integration of this material into patients' tissues and merit further study in physiologically relevant animal models.
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Affiliation(s)
- Naşide Mangır
- Department of Materials Science Engineering, Kroto Research Institute, University of Sheffield, UK; Royal Hallamshire Hospital, Department of Urology, Sheffield, UK
| | - Christopher J Hillary
- Department of Materials Science Engineering, Kroto Research Institute, University of Sheffield, UK; Royal Hallamshire Hospital, Department of Urology, Sheffield, UK
| | | | - Sheila MacNeil
- Department of Materials Science Engineering, Kroto Research Institute, University of Sheffield, UK.
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Singh W, Wadhwa H, Halgrimson W, Kocjancic E. Role of ultrasound imaging in advancing treatment of female patients with pelvic floor mesh complications. World J Obstet Gynecol 2016; 5:73-77. [DOI: 10.5317/wjog.v5.i1.73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 10/14/2015] [Accepted: 12/11/2015] [Indexed: 02/05/2023] Open
Abstract
Application of vaginal mesh for stress urinary incontinence has seen widespread use due to its relatively short operative time in combination with its efficacy in treatment. However, vaginal mesh is not without its drawbacks and can lead to mesh erosion or extrusion, infection, dyspareunia, and recurrence of incontinence. Vaginal mesh complications can lead to feelings of hopelessness, isolation, shame, and emotional distress. Furthermore, failure to identify and address these complications in a timely manner can be permanently damaging to patient health. It is vital to be able to identify mesh complications early. Various imaging methodologies exist to visualize vaginal mesh placement and complications, including ultrasound, magnetic resonance imaging (MRI), and computed tomography (CT). This invited review paper focuses on the role of ultrasound in mesh visualization, mesh complication identification, and operative planning in the event of subsequent surgical mesh revision. Polypropylene mesh is echogenic on ultrasound, making it a useful tool for visualizing post-operative mesh placement. Transperineal, translabial and endovaginal ultrasound technique use has been described in the pre- and peri-operative setting to identify mesh in complex cases. Efficacy and practicality of CT and MRI use in identifying mesh in these cases is limited.
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Castroviejo-Royo F, Rodríguez-Toves LA, Martínez-Sagarra-Oceja JM, Conde-Redondo C, Mainez-Rodríguez JA. Outcomes of transurethral resection (TUR) of intravesical mesh after suburethral slings in the treatment of urinary stress incontinence. Actas Urol Esp 2015; 39:183-7. [PMID: 25457565 DOI: 10.1016/j.acuro.2014.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 09/28/2014] [Accepted: 09/29/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of this study was to determine the efficacy as well as the complications associated with transurethral removal (TUR) of intravesical mesh after suburethral sling, transobturator tape-TOT (Monarc™) or "minisling" (MiniArc(®)), in the treatment of female urinary stress incontinence (USI). MATERIAL AND METHODS retrospective and consecutive study on 9 women with bladder perforation after midurethral slings (3 Monarc™ and 6 MiniArc®) placement for urinary stress incontinence. To remove the mesh, transurethral resection with an electrode loop (TUR-E) was used. The technique included: location and total removal of mesh with bipolar resectoscope up to healthy tissue. RESULTS The median age was 61 years (49-70 years). The median time between midurethral sling placement and onset the sympltoms was 13 months (1-79 months). and between sling placement and mesh removal was 16 months (1-91 months). Five women (55.5%) developed bladder stones. Mean operating time was 29.4 ± 10.4 minutes and mean length of hospital stay was 2.6 ± 0.5 days. The median follow-up after mesh removal was 38 months (range, 14 to 109 months). No complications were found. CONCLUSIONS The use of transurethral resection of intravesical mesh after suburethral slings is easy and the results obtained by our surgical team are excellent.
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Affiliation(s)
- F Castroviejo-Royo
- Servicio de Urología, Hospital Universitario Río Hortega, Valladolid, España.
| | - L A Rodríguez-Toves
- Servicio de Urología, Hospital Universitario Río Hortega, Valladolid, España
| | | | - C Conde-Redondo
- Servicio de Urología, Hospital Universitario Río Hortega, Valladolid, España
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Abstract
STUDY OBJECTIVE To demonstrate surgical maneuvers to facilitate laparoscopic excision of sacrocolpopexy mesh and prevent potential complications. DESIGN Step-by-step illustration of various surgical techniques using a video compiled from 3 laparoscopic sacrocolpopexy mesh excision procedures performed at Magee-Womens Hospital for various indications (Canadian Task Force classification xx-xx). SETTING Mesh complications such as infection and erosion are frequently managed conservatively but often necessitate mesh excision for symptom relief. Laparoscopic excision of sacrocolpopexy mesh procedures is typically challenging, even in the hands of experienced surgeons. Synthetic mesh, being a foreign body, activates an inflammatory process that leads to surrounding tissue fibrosis and scar tissue formation that can distort the pelvic anatomy, thereby putting vital organs at risk of injury. Such organs include the bladder, rectum, and vagina caudally; the left common iliac vein and middle sacral vessels cephalad; and the ureters at the level of the vaginal cuff angles. INTERVENTION Laparoscopic excision of sacrocolpopexy mesh. CONCLUSION When planning laparoscopic sacrocolpopexy mesh excision, complications can be prevented with use of proper surgical technique. It is important to identify vital structures because they may be displaced due to tissue fibrosis. When developing various surgical planes, surgeons should first operate in areas that are free of adhesions. This will enhance exposure when dissecting the mesh in proximity of scarred tissue and vital organs. Use of vaginal and rectal probes helps to delineate the vesicovaginal and rectovaginal spaces to prevent bladder and bowel injury.
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Affiliation(s)
- Dina Chamsy
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
| | - Ted Lee
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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