Severe Mesh Complications Following Intravaginal Slingplasty

Baeßler, Kaven; Hewson, Alan D.; Tunn, Ralf; Schuessler, Bernhard; Maher, Christopher

doi:10.1097/01.aog.0000177970.52037.0a

Cited by 161 publications

(38 citation statements)

References 15 publications

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“…Pelvic abscesses and rectovaginal or vesicovaginal fistula are also reported [13–17]. These complications occur in approximately 10% of patients and may lead to a significant decrease in quality of life [8–11, 18–20].…”

Section: Introductionmentioning

confidence: 99%

Surgical management of mesh-related complications after prior pelvic floor reconstructive surgery with mesh

et al. 2011

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Introduction and hypothesisThe objective of this study is to evaluate the complications and anatomical and functional outcomes of the surgical treatment of mesh-related complications.MethodsA retrospective cohort study of patients who underwent complete or partial mesh excision to treat complications after prior mesh-augmented pelvic floor reconstructive surgery was conducted.ResultsSeventy-three patients underwent 30 complete and 51 partial mesh excisions. Intraoperative complications occurred in 4 cases, postoperative complications in 13. Symptom relief was achieved in 92% of patients. Recurrence of pelvic organ prolapse (POP) occurred in 29% of complete and 5% of partial excisions of mesh used in POP surgery. De novo stress urinary incontinence (SUI) occurred in 36% of patients who underwent excision of a suburethral sling.ConclusionsMesh excision relieves mesh-related complications effectively, although with a substantial risk of serious complications and recurrence of POP or SUI. More complex excisions should be performed in skilled centers.

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Section: Introductionmentioning

confidence: 99%

Surgical management of mesh-related complications after prior pelvic floor reconstructive surgery with mesh

et al. 2011

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“…The mesh material was optimized for rapid MRI to facilitate better detection of mesh placement in the pelvic floor and potentially find the origin of complications related to mesh repair. In the current literature, meshes in general and misplaced ones in particular might be the cause of nerve irritations, uncertain postsurgical pelvic floor pain, or dyspareunia [6,16,17]. The published rates of complications such as mesh erosion, de novo dyspareunia, and pelvic organ prolapse recurrence are heterogeneous [6,7].…”

Section: Discussionmentioning

confidence: 99%

“…In the current literature, meshes in general and misplaced ones in particular might be the cause of nerve irritations, uncertain postsurgical pelvic floor pain, or dyspareunia [6,16,17]. The published rates of complications such as mesh erosion, de novo dyspareunia, and pelvic organ prolapse recurrence are heterogeneous [6,7]. Until now it has often not been possible to determine a definite reason for their occurrence because the complete location of the mesh and its anchoring mesh arms were not visible [6,7,17].…”

Section: Discussionmentioning

confidence: 99%

“…The published rates of complications such as mesh erosion, de novo dyspareunia, and pelvic organ prolapse recurrence are heterogeneous [6,7]. Until now it has often not been possible to determine a definite reason for their occurrence because the complete location of the mesh and its anchoring mesh arms were not visible [6,7,17]. …”

Section: Discussionmentioning

confidence: 99%

“…The current literature on complications after mesh surgery includes reports on postoperative pain, hematoma, nerve distractions, mesh shrinking, de novo dyspareunia, and infections [6,7]. To assess surgical outcome and postoperative complications, the patients' subjective rating is combined with clinical examination and ultrasound imaging.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Magnetic Resonance-Visible Polypropylene Mesh for Pelvic Organ Prolapse Repair

Brocker¹,

Lippus

Alt

et al. 2014

Gynecol Obstet Invest

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Aim: To develop a magnetic resonance (MR)-visible mesh using iron oxides and prove visibility. Methods: In a phantom study, a suitable iron oxide, Fe₃O₄ [iron(II,III) oxide] and FeOOH [iron(III) oxide-hydroxide], concentration was determined using relaxometric MR measurements of the transverse relaxation rates R2 and R2*. Next, a nonabsorbable mesh was designed from the MR-visible threads woven into a polypropylene mesh. The mesh was implanted into a fresh female cadaver via the transobturator route, and MR visibility was assessed with various MR pulse sequences in a clinical 3-tesla system. Results: Optimal contrast was achieved with Fe₃O₄ at 0.2 weight-% in all imaging sequences, and the optimal contrast was achieved in a 3D spoiled gradient-echo (fast low-angle shot) acquisition. In this concentration range the apparent transverse relaxation rate R2* is below 10 ms. The mesh was visible in the cadaver on T1-weighted 3D spoiled gradient-echo images and T1-weighted fast spin-echo images. Conclusion: Mesh materials can be manufactured to be visible on MR with a negative contrast. Fe₃O₄ meshes could simplify follow-up examinations and help diagnose origins of postsurgical lesions after urogynecological procedures with mesh material.

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Surgical management of pelvic organ prolapse in women

Maher¹,

Carey²,

Adams

et al. 2003

Cochrane Database of Systematic Reviews

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Background Pelvic organ prolapse may occur in up to 50% of parous women. A variety of urinary, bowel and sexual symptoms may be associated with the prolapse. Objectives To determine the effects of the many different surgeries used in the management of pelvic organ prolapse. Search methods We searched the Cochrane Incontinence Group Specialised Register (9 February 2009) and reference lists of relevant articles. We also contacted researchers in the field. Selection criteria Randomised or quasi-randomised controlled trials that included surgical operations for pelvic organ prolapse. Data collection and analysis Trials were assessed and data extracted independently by two review authors. Six investigators were contacted for additional information with five responding. Main results Forty randomised controlled trials were identified evaluating 3773 women. Abdominal sacral colpopexy was better than vaginal sacrospinous colpopexy in terms of a lower rate of recurrent vault prolapse (RR 0.23, 95% CI 0.07 to 0.77) and less dyspareunia (RR 0.39, 95% CI 0.18 to 0.86). However there was no statistically significant difference in re-operation rates for prolapse (RR 0.46, 95% CI 0.19 to 1.11). The vaginal sacrospinous colpopexy was quicker and cheaper to perform and women had an earlier return to activities of daily living. The three trials contributing to this analysis were clinically heterogeneous. For anterior vaginal wall prolapse, standard anterior repair was associated with more recurrent cystoceles than when supplemented with a polyglactin mesh inlay (RR 1.39, 95% CI 1.02 to 1.90) or porcine dermis mesh inlay (RR 2.72, 95% CI 1.20 to 6.14); but data on morbidity and other clinical outcomes were lacking. Standard anterior repair was associated with more anterior compartment failures 1 Surgical management of pelvic organ prolapse in women (Review)

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Severe Mesh Complications Following Intravaginal Slingplasty

Abstract: Surgeons should be aware of the potential complications of synthetic meshes. Until data on the safety and efficacy of the intravaginal slingplasties are available, these procedures cannot be recommended.

Cited by 161 publications

References 15 publications

Surgical management of mesh-related complications after prior pelvic floor reconstructive surgery with mesh

Surgical management of mesh-related complications after prior pelvic floor reconstructive surgery with mesh

Magnetic Resonance-Visible Polypropylene Mesh for Pelvic Organ Prolapse Repair

Surgical management of pelvic organ prolapse in women

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