Short-term efficacy and complications of posterior intravaginal slingplasty

Abstract

This study was performed to evaluate the efficacy and complications of the posterior intravaginal slingplasty (IVS). A retrospective chart review was performed. Ninety IVS procedures were performed from January 2004 to June 2005. The group consisted of predominantly nonsmoking, Caucasian, postmenopausal women with a median age of 62 years and a median parity of 3. The mean follow-up was 33 +/- 23.2 weeks with a median of 31.9 weeks. There were no intraoperative bladder, bowel, or vascular injuries. Overall, 11 out of 90 patients developed recurrent or de novo prolapse; 4.4% of these had recurrent apical prolapse. There was a 17.8% incidence of mesh erosion. Only 1 of the 11 patients with recurrent prolapse had concomitant mesh erosion. The procedure demonstrated an unacceptably high erosion rate. The adoption of newer mesh techniques based on the slingplasty concept or the use of the multifilament polypropylene tape should be scrutinized.

Complex pelvic floor failure and associated problems

“…A short vagina is often not amenable to vaginal sacrospinous colpopexy [107]. Disadvantages of the IVS operation are usually related to the failure of the non-absorbable mesh to be secured, a high erosion rate of at least 18% [108,109], gluteovaginal fistula formation [110], and gluteo-vaginal sinus formation [111].…”

Atypical Graft Infection Presenting as a Remote Draining Sinus

“…Several authors have reported retrospectively an unusually high rate of graft erosion or infection or both ranging from 4 -18% associated with use of the multifilament intravaginal slingplasty tape. 2,4 Serious graft complications leading to retropubic abscess, vesicovaginal fistula, and cutaneous suprapubic fistula have been reported. 5 This case is unique because the infection presented outside of the pelvis, thus not alerting us of its relationship to a previous implant.…”

“…Like with our patient, other authors have reported that excision of infected grafts does not necessarily result in prolapse recurrence in short-term follow-up studies. 2,3 Knowing the composition of synthetic implanted materials and their biologic behavior is essential for the appropriate selection of graft materials for incontinence and prolapse surgery and fundamental for the effective management of postoperative complications. This case report illustrates the importance of maintaining a high index of suspicion in patients with atypical infections in sites remote from the original operative site in those with either recent or remote reconstructive pelvic surgery using non-type I synthetic mesh materials.…”

“…Although the intravaginal slingplasty procedure has demonstrated a short-term success rate of 88 -95%, it has been associated with mesh complications. [1][2][3] We describe a case of delayed graft infection after posterior intravaginal slingplasty vaginal vault suspension presenting 18 months postoperatively as a distant, draining fistulous tract to the lower extremity.…”

Quoi de neuf depuis le rapport de la HAS ? Bilan de deux ans d’évaluation des implants de renfort prothétique dans le traitement des prolapsus par voie vaginale

“…Luck et al [6] étudient une série de 90 patientes traitées par IVS postérieur pour prolapsus apical de stade supérieur ou égal à 1 (Baden et Walker). Une prothèse antérieure est associée dans 66,6 % (60/90) des cas.…”