Colovaginal fistula: A rare long-term complication of polypropylene mesh sacrocolpopexy

We reviewed the incidence, predisposing factors, presentation and management of complications related to the use of synthetic mesh in the management of stress urinary incontinence and pelvic organ prolapse repair. Immediate complications, such as bleeding, hematoma, injury to adjacent organs during placement of mesh and complication of voiding dysfunction are not discussed in this review, since they are primarily related to technique. A PubMed search of related articles published in English was done from April 2008 to March 2011. Key words used were urinary incontinence, mesh, complications, midurethral sling, anterior prolapse, anterior vaginal repair, pelvic organ prolapse, transvaginal mesh, vault prolapse, midurethral slings, female stress urinary incontinence, mesh erosion, vaginal mesh complications, and posterior vaginal wall prolapse. Since there were very few articles dealing with the management of mesh-related complications in the period covered in the search we extended the search from January 2005 onwards. Articles were selected to fit the scope of the topic. In addition, landmark publications and Manufacturer and User Facility Device Experience (MAUDE) data (FDA website) were included on the present topic. A total of 170 articles were identified. The use of synthetic mesh in sub-urethral sling procedures is now considered the standard for the surgical management of stress urinary incontinence. Synthetic mesh is being increasingly used in the management of pelvic organ prolapse. While the incidence of extrusion and erosion with mid-urethral sling is low, the extrusion rate in prolapse repair is somewhat higher and the use in posterior compartment remains controversial. When used through the abdominal approach the extrusion and erosion rates are lower. The management of mesh complication is an individualized approach. The choice of the technique should be based on the type of mesh complication, location of the extrusion and/or erosion, its magnitude, severity and potential recurrence of pelvic floor defect.

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“…The possible mechanisms are intraoperative injury, mechanical injury by mesh alone or in conjuction with local sepsis. [151152]…”

Section: Mesh Complicationsmentioning

confidence: 99%

Mesh complications in female pelvic floor reconstructive surgery and their management: A systematic review

2012

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“…16,105,261,277,301,312,326 Mesh erosions in the bowel Bowel mesh erosions are exceedingly rare and all known patients with bowel erosions have presented with an enterovaginal fistula. 9,327,328 Treatment requires removal of all intra-abdominal mesh and repair or excision of the affected bowel. In our own clinical experience, a patient who had bowel mesh erosion had an associated vesicovaginal fistula and after several unsuccessful r econstructive surgeries required a continent urinary diversion.…”

Section: Reviewsmentioning

confidence: 99%

Safety considerations for synthetic sling surgery

et al. 2015

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Implantation of a synthetic midurethral sling (SMUS) is the most commonly performed anti-incontinence operation in women worldwide. The effectiveness of the SMUS is comparable to that of the historical gold standards--autologous fascial slings and the Burch colposuspension. Much controversy, however, has evolved regarding the safety of this type of sling. Overall, the quality of the studies with respect to assessing risks of SMUS-associated complications is currently poor. The most common risks in patients with SMUS include urethral obstruction requiring surgery (2.3% of patients with SMUS), vaginal, bladder and/or urethral erosion requiring surgery (1.8%) and refractory chronic pain (4.1%); these data likely represent the minimum risks. In addition, the failure rate of SMUS implantation surgery is probably at least 5% in patients with stress urinary incontinence (SUI). Furthermore, at least one-third of patients undergoing sling excision surgery develop recurrent SUI. Considering the additional risks of refractory overactive bladder, fistulas and bowel perforations, among others, the overall risk of a negative outcome after SMUS implantation surgery is ≥15%.

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“…Des érosions tardives viscérales (vésicale et digestive) ont été rapportées en promontofixation [32,47,48] et en chirurgie vaginale (éro-sion urétérale et digestive) [49,50]. La prévalence globale de ces érosions viscérales tardives est comprise entre 0,5 et 1 % pour la promontofixation coelioscopique [27] (NP4).…”

Section: Exposition Prothétique Viscérale (éRosion Vésicale Ou Digestunclassified

Prévenir les complications de la chirurgie prothétique du prolapsus : recommandations pour la pratique clinique – Revue de la littérature

Deffieux

Savary

Letouzey

et al. 2011

Journal de Gynécologie Obstétrique et Biologie de la Reproducti

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Colovaginal fistula: A rare long-term complication of polypropylene mesh sacrocolpopexy

Cited by 9 publications

References 6 publications

Mesh complications in female pelvic floor reconstructive surgery and their management: A systematic review

Mesh complications in female pelvic floor reconstructive surgery and their management: A systematic review

Safety considerations for synthetic sling surgery

Prévenir les complications de la chirurgie prothétique du prolapsus : recommandations pour la pratique clinique – Revue de la littérature

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