Conservative Management of Spondylodiscitis after Laparoscopic Sacral Colpopexy: A Case Report and Review of Literature

AbstractSacral colpopexy is one of the standard procedures to treat apical pelvic organ prolapse. In most cases, a synthetic mesh is used to facilitate the colposuspension. Spondylodiscitis is a rare but potentially serious complication that must be promptly diagnosed and treated, despite the lack of consensus in the management of this complication. We report one case of spondylodiscitis after a laparoscopic supracervical hysterectomy and sacral colpopexy treated conservatively. We also present a literature review regarding this rare complication. A conservative approach without mesh removal may be possible in selected patients (stable, with no vaginal lesions, mesh exposure or severe neurologic compromise). Hemocultures and culture of image-guided biopsies should be performed to direct antibiotic therapy. Conservative versus surgical treatment should be regularly weighted depending on clinical and analytical progression. A multidisciplinary team is of paramount importance in the follow-up of these patients.

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Long-term observation on postoperative recurrence and complications of transvaginal mesh surgery for pelvic organ prolapse

Gynecologic and Obstetric Investigation ◽

10.1159/000520979 ◽

2021 ◽

Author(s):

Junfang Yang ◽

Kun Zhang ◽

Jinsong Han ◽

Yiting Wang ◽

Ying Yao ◽

...

Keyword(s):

Risk Factors ◽

Pelvic Organ Prolapse ◽

Protective Factor ◽

Pelvic Organ ◽

Vaginal Mesh ◽

Transvaginal Mesh ◽

Mesh Exposure ◽

Mesh Surgery ◽

Post Menopause

Objective: This study aims to evaluate the risk factors for subjective recurrence and complications of patients who underwent transvaginal synthetic mesh surgery. Design：This retrospective cohort study included patients who received transvaginal mesh (TVM) surgery between January 2005 and June 2019. Methods: The information of patients was collected, including basic characteristics, subjective recurrence, and mesh-related complications. The clinical characteristics of patients with and without subjective recurrence were compared. The sexual activities of patients before and after the operation were recorded. SPSS 20.0 was used for the statistical analysis. Results: A total of 257 patients were included. Among them, 62 (24.1%) patients were lost to follow-up. The median follow-up time was 80 months (12 months, 170 months). Finally, 195 patients were followed up, 11 (5.6%) patients had a subjective recurrence of pelvic organ prolapse, and 26 (13.3%) patients had mesh-related complications (11 patients with de novo pain and 15 patients with mesh exposure). We found significant differences in age (68.9±5.1 vs. 63.4±5.8 years old), years of post-menopause (17.5±6.3 vs. 13.3±6.9 years), previous hysterectomy (27.3% vs. 6.0%), and concomitant hysterectomy (45.5% vs. 81.0%) between patients with and without subjective recurrence (P<0.05). The mesh exposure proportion of patients with total vaginal mesh (47.6%) was significantly higher than that with anterior vaginal mesh (2.9%) (P<0.05). Furthermore, 6.7% of sexually active patients reported do novo dyspareunia. Limitation: The investigators could only record the subjective recurrence of patients, thus there is a lack of objective recurrence data. Conclusion: Age, years of post-menopause and previous hysterectomy are risk factors for subjective recurrence of transvaginal mesh surgery; however，concomitant hysterectomy is a protective factor. Mesh exposure is the most common complication, especially for total vaginal mesh repair surgery.

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Clinical analysis of pain after transvaginal mesh surgery in patients with pelvic organ prolapse

10.21203/rs.3.rs-38744/v1 ◽

2020 ◽

Author(s):

Chang Shi ◽

Ying Zhao ◽

Qing Hu ◽

Runqi Gong ◽

Yitong Yin ◽

...

Keyword(s):

Pelvic Organ Prolapse ◽

Statistical Significance ◽

Pelvic Organ ◽

Transvaginal Mesh ◽

Mesh Exposure ◽

Mesh Removal ◽

Mesh Surgery ◽

Significant Difference ◽

Relief Rate ◽

Surgical Treatments

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 analyze the management and relief of the pain. Methods A retrospective study of a clinical database of patients who underwent TVM surgery was conducted, and pain related aspects were analyzed. Results The incidence of pain after TVM surgery was 2.70% (50/1855), with a median occurrence time of 7.5 months. Pain symptoms mainly involved vagina, perineum, buttocks, groin, inner thighs, and lower abdomen. Greater 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 analyzed as risk factors with statistical significance. Mesh exposure rate in pain group was 38%, showing a significant difference between groups (P < 0.01). Forty patients underwent non-surgical treatments, with a relief rate of 40.0%; 33 patients were performed surgical treatments, 15 of which 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 postoperative anatomic failure can increase the risk of postoperative pain; mesh exposure, mesh contracture, and mesh position abnormality are also associated. Most patients can get pain relief with proper management, more than half of which may need mesh removal with differing amounts.

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Clinical analysis of pain after transvaginal mesh surgery in patients with pelvic organ prolapse

BMC Women s Health ◽

10.1186/s12905-021-01192-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Chang Shi ◽

Ying Zhao ◽

Qing Hu ◽

Runqi Gong ◽

Yitong Yin ◽

...

Keyword(s):

Surgical Treatment ◽

Pelvic Organ Prolapse ◽

Statistical Significance ◽

Pelvic Organ ◽

Transvaginal Mesh ◽

Mesh Exposure ◽

Mesh Removal ◽

Mesh Surgery ◽

Significant Difference ◽

Relief Rate

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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Robotic-Assisted Laparoscopic Sacrocolpopexy for Pelvic Organ Prolapse: A Single Center Experience in China

Journal of Healthcare Engineering ◽

10.1155/2022/6201098 ◽

2022 ◽

Vol 2022 ◽

pp. 1-5

Author(s):

Ke Niu ◽

Qingzhi Zhai ◽

Wensheng Fan ◽

Li’an Li ◽

Wen Yang ◽

...

Keyword(s):

Pelvic Organ Prolapse ◽

Life Quality ◽

Operation Time ◽

Pelvic Organ ◽

Mesh Exposure ◽

Robotic Assisted ◽

Single Center Experience ◽

Hospitalization Time ◽

Mesh Excision

Objective. The aim is to investigate the efficiency and outcome of robotic-assisted sacrocolpopexy (RASC) in a cohort of patients with pelvic organ prolapse (POP) in our Gynecology Department. Methods. We performed a retrospective study of female patients who underwent RASC in Chinese PLA General Hospital from January 2013 to December 2020. Their clinical features included age, degree of prolapse, menopause time, body mass index, pregnancy, delivery, operation time, and bleeding volume. All patients were followed up for more than 6 months. POP-Q was recorded to evaluate the position of prolapsed organs. PFDI-20, PFIQ-7, and PGI-I were used to evaluate the life quality after surgery. Results. Twenty-four patients with POP received RASC in our center. The intraoperative bleeding was 86.9 ± 98.3 ml (20–300 ml). The operation time was 143.5 ± 47.3 min (60–240 minutes). The hospitalization time was 10.4 ± 2.1 days (8–16 days). And the follow-up time was 40.8 ± 22.0 months (6–72 months). In the POP-Q follow-up, postoperative Aa, Ba, Ap, Bp, and C were significantly improved than those before surgery ( P < 0.05 ). The objective and subjective cure rate was 100%. PGI-I score was very good in 9 (9/24), very good in 10 (10/24), and good in 3 (3/24). Postoperative PFDI-20 and PFIQ-7 were 2.78 ± 3.82 and 1.57 ± 3.86, which decreased dramatically after surgery ( P < 0.05 ). Mesh exposure occurred in 4 cases (16.7%) at 2–12 months. The exposed diameters were less than 1 cm in 3 cases (2 A/T3/S1) and 1-2 cm in 1 case (3 B/T3/S1). These mesh exposures healed after conservative observation or mesh excision. Conclusion. RASC for POP has the advantage of less bleeding and hospitalization time. It is a minimally invasive option for pelvic organ prolapse.

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Sacrocolpopexy using autologous rectus fascia: cohort study of long-term outcomes and complications

10.22541/au.163252456.68051157/v1 ◽

2021 ◽

Author(s):

Rui Wang ◽

Krista Reagan ◽

Sarah Boyd ◽

Paul Tulikangas

Keyword(s):

Cohort Study ◽

Pelvic Organ Prolapse ◽

Medical Center ◽

Academic Medical Center ◽

Pelvic Organ ◽

Synthetic Mesh ◽

Composite Failure ◽

Abdominal Sacrocolpopexy ◽

Rectus Fascia

Objective: To evaluate objective and subjective outcomes of patients who underwent sacrocolpopexy using autologous rectus fascia to provide more data regarding non-mesh alternatives in pelvic organ prolapse surgery. Design: Cohort study with retrospective and prospective data. Setting: A single academic medical center. Population: Women who underwent abdominal sacrocolpopexy using autologous rectus fascia between January 2010 and December 2019 Methods: Patients were recruited for a follow-up visit including completing the Pelvic Floor Distress Inventory (PFDI) and Pelvic Organ Prolapse Quantification (POPQ) exam. Demographic and clinical characteristics were collected. Main Outcome Measures: Composite failure, anatomic failure, symptomatic failure, and retreatment. Results: During the study period, 132 women underwent sacrocolpopexy using autologous rectus fascia. Median follow-up time was 2.2 years. Survival analysis showed that composite failure was 0.8% (CI 0.1-5.9%) at 12 months, 3.5% (CI 1.1-10.7%) at 2 years, 13.2% (CI 7.0-24.3%) at 3 years, and 28.3% (CI 17.0-44.8%) at 5 years. Anatomic failure was 0% at 12 months, 1.4% (CI 0.2-9.2%) at 2 years, 3.1% (CI 0.8-12.0%) at 3 years, and 6.8% (CI 2.0-22.0%) at 5 years. Symptomatic failure rate was 0% at 12 months, 1.3% (CI 0.2-9.0%) at 2 years, 2.9% (CI 0.7-11.3%) at 3 years, and 13.1% (CI 5.3-30.3%) at 5 years. Retreatment rate was 0.8% (CI 0.1-5.9%) at 12 months and 2 years, 9.4% (CI 4.2-20.3%) at 3 years, and 13.0% (CI 6.0-27.2%) at 5 years. Conclusions: Autologous rectus fascia sacrocolpopexy may be considered a safe and effective alternative for patients who desire to avoid synthetic mesh.

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Radiation induced angiosarcoma of the hypopharynx: a rare case report and review of literature

Journal of Otolaryngology-ENT Research ◽

10.15406/joentr.2019.11.00417 ◽

2019 ◽

Vol 11 (2) ◽

pp. 104-106

Author(s):

Eyad Darraj

Keyword(s):

Head And Neck ◽

Rare Complication ◽

Review Of Literature ◽

Treatment Regimes ◽

Rare Case Report ◽

Radiation Induced ◽

Estimated Risk ◽

Post Radiation

Radiation-induced sarcoma in the head and neck is a long-term rare complication of radiation therapy, with an estimated risk of up to 0.3%. The incidence of these sarcomas is, however, likely to increase due to the progressive aging of the population combined with improved survival in head and neck cancer patients resulting from better treatment regimes. This is a case of post -radiation sarcoma of the hypopharynx radiated for tongue carcinoma previously. This case is reported to high light a rare but devastating complication of radiotherapy that is to be kept in mind during follow up.

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A multicenter, randomized trial comparing pelvic organ prolapse surgical treatment with native tissue and synthetic mesh: A 5‐year follow‐up study

Neurourology and Urodynamics ◽

10.1002/nau.24323 ◽

2020 ◽

Vol 39 (3) ◽

pp. 1002-1011 ◽

Cited By ~ 1

Author(s):

Simone dos Reis B. Silveira ◽

Antomio PF. Auge ◽

Zsuzsanna IK. Jarmy‐Dibella ◽

Paulo FR. Margarido ◽

Silvia Carramao ◽

...

Keyword(s):

Surgical Treatment ◽

Pelvic Organ Prolapse ◽

Randomized Trial ◽

Pelvic Organ ◽

Synthetic Mesh ◽

Follow Up Study ◽

Native Tissue ◽

Multicenter Randomized Trial

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Outcomes of robotically assisted laparoscopic lateral suspension (RALLS) with mesh for anterior and apical prolapse

Journal of Robotic Surgery ◽

10.1007/s11701-021-01234-3 ◽

2021 ◽

Author(s):

Patrick Dällenbach ◽

Milena Alec ◽

Michel Boulvain ◽

Stas Shabanov

Keyword(s):

De Novo ◽

Perioperative Complications ◽

Pelvic Organ ◽

Sacral Colpopexy ◽

Cure Rate ◽

Patient Global Impression ◽

Laparoscopic Lateral Suspension ◽

Life Threatening ◽

Objective Cure

AbstractAbdominal sacral colpopexy/hysteropexy is the gold standard for the treatment of vaginal apex support. However, dissection of the promontory may expose to potentially life-threatening complications. To avoid this risk, laparoscopic lateral suspension with mesh is an alternative. Robotic assistance may be helpful in both techniques. The objective of our study was to evaluate outcomes of robotically assisted laparoscopic lateral suspension (RALLS) with mesh for anterior and apical pelvic organ prolapse (POP). From March 2012 to January 2018, 59 consecutive patients underwent RALLS using titanized polypropylene mesh. Between August 2017 and September 2019, all patients were contacted to assess outcome. We performed a clinical exam and asked them to complete the patient global impression of improvement (PGI-I) questionnaire. Fifty-four patients (91.5%) were available for follow-up. Mean age was 58.5 years (28.8–79.8). There were no perioperative complications. The mean follow-up was 33.6 months (11.2–74.1).The objective cure rate (no prolapse beyond hymen) and the subjective cure rate (PGI-I ≤ 2) were 83.3% and 77.2%, respectively. Five women (9.3%) were reoperated for POP recurrence. There was no erosion. Of the 20 women complaining of stress urinary incontinence (SUI) preoperatively, 12 (60%) were cured without any additional SUI procedure. Only two women (10%) required TVT for persistent grade 2 SUI. Two women (5.9%) developed de novo SUI, but none of them required an operation. RALLS repair for POP with mesh is safe and effective and may represent an alternative to sacral colpopexy/hysteropexy.

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The incidence of mesh extrusion after vaginal incontinence and pelvic floor prolapse surgery

Journal of Hospital Administration ◽

10.5430/jha.v3n4p76 ◽

2014 ◽

Vol 3 (4) ◽

pp. 76

Author(s):

Seth Cohen ◽

Elizabeth Kavaler

Keyword(s):

Reconstructive Surgery ◽

Survival Function ◽

Pelvic Organ ◽

Synthetic Mesh ◽

Anterior Repair ◽

Vaginal Reconstructive Surgery ◽

Pelvic Floor Prolapse ◽

One Year

Purpose: The advantages of using synthetic mesh in vaginal reconstructive surgery are significant. However, the concern about extrusion has led many to question its use. We wished to learn the extrusion rates and time to extrusion in patients undergoing vaginal stress incontinence and prolapse surgeries using polypropylene mesh. Materials and methods: Five hundred and seventy six women underwent vaginal reconstructive surgery with synthetic mesh between August 2000 and October 2009 for the treatment of stress urinary incontinence, with or without pelvic organ prolapse repair. 367 patients had at least one year follow-up. Procedures were: pubo-vaginal sling (PVS), PVS and anterior repair, PVS with anterior and/or posterior repairs, and PVS with hysterectomy and anterior and posterior repairs. Time to mesh extrusion was estimated using a survival function curve. Results: Forty-two (11.4%) patients sustained a mesh extrusion. The rate of mesh extrusion was (6.3%) in the PVS group, (14.7%) in the PVS and anterior repair group, (11.1%) in the PVS with anterior and posterior repairs group and (5%) in the PVS with hysterectomy and anterior and posterior repair. Percent extrusion free at one to four years post-op was (91%) and (85%). Conclusion: Our study provides a large series of prolapse cases performed by a single surgeon with follow-up that extends at least one year, with the longest follow-up at eight years. The incidence of long term mesh extrusion needs to be considered with respect to the support advantages of synthetic mesh in planning vaginal reconstructive surgery.

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Clinical analysis of pain after transvaginal mesh surgery in patients with pelvic organ prolapse

10.21203/rs.3.rs-38744/v2 ◽

2020 ◽

Author(s):

Chang Shi ◽

Ying Zhao ◽

Qing Hu ◽

Runqi Gong ◽

Yitong Yin ◽

...

Keyword(s):

Surgical Treatment ◽

Pelvic Organ Prolapse ◽

Statistical Significance ◽

Pelvic Organ ◽

Transvaginal Mesh ◽

Mesh Exposure ◽

Mesh Removal ◽

Mesh Surgery ◽

Significant Difference ◽

Relief Rate

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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