The Burden of Reoperations and Timeline of Problems in 1,530 Cases of Mesh-Related Complications

2021 ◽  
pp. 1-8
Author(s):  
Paulo Rodrigues ◽  
Shlomo Raz
Keyword(s):  
Clinical Presentation ◽  
Complex Interventions ◽  
Complete Removal ◽  
Time Frame ◽  
Pelvic Organ ◽  
Pelvic Floor Reconstruction ◽  
Tertiary Center ◽  
Surgical Treatments ◽  
Voiding Dysfunctions ◽  
Clinical Complaint

<b><i>Background:</i></b> Mesh-related complications resulting from pelvic organ prolapse (POP) reconstruction operations may be a devastating experience leading to multiple and complex interventions. <b><i>Objectives:</i></b> The aim of the study was to describe the experience and time frame of management of mesh-related complications in women treated for POP or stress urinary incontinence in a tertiary center. <b><i>Methods:</i></b> 1,530 cases of mesh-related complications were accessed regarding their clinical presentation, number of surgeries, and timeline of surgical treatments to treat multiple clinical complaints until the ultimate operation where all the meshes were removed in a single tertiary center. <b><i>Results:</i></b> The studied population revealed to be a highly referred one with only 10.2% of the cases implanted at our center. Clinical presentation varied widely with 48.7% referring pain as the chief complaint, while 31.3% complained of voiding dysfunctions, 2.5% reported genital prolapses, 2.2% complained of vaginal problems, and 1.2% noted intestinal problems as the main clinical complaint. Only 4.8% of the cases presented mesh erosion at examination; 57.8% of the cases required more than 1 operation to address the mesh-related problems. Sixty-eight cases had more than 10 operations up to complete removal. Three clusters of patients could be identified: (i)–those from whom the mesh was promptly removed after clinical problems emerged, (ii) those with slowly evolving problems, and (iii) those with escalating problems despite treatment attempts. <b><i>Conclusions:</i></b> Mesh-related complications after pelvic floor reconstruction are an evolving disease with diverse clinical presentation. The identified time-related problems and the multiple failed attempts to treat their complications warrant attention with continuous monitoring of these patients and aggressive removal of the mesh if the clinical complaint cannot be swiftly managed.

Transient ureteric obstruction following pelvic floor reconstruction

2021 ◽  
Vol 14 (5) ◽  
pp. e238669
Author(s):  
Liam Joseph Beamer ◽  
Sarah Neary ◽  
Thomas McCormack ◽  
David Ankers
Keyword(s):  
Pelvic Floor ◽  
Kidney Injury ◽  
Solitary Kidney ◽  
Percutaneous Nephrostomy ◽  
Pelvic Organ ◽  
Ureteric Obstruction ◽  
Pelvic Floor Reconstruction ◽  
Transient Nature ◽  
Recurrent Pelvic Organ Prolapse ◽  
History Of

We describe the first reported case of transient distal ureteric obstruction attributed to post-surgical oedema in a patient with a solitary kidney. This occurred following combined pelvic floor repair and sacrospinous fixation for recurrent pelvic organ prolapse and manifested clinically as anuria, radiological hydroureter and acute kidney injury in the postoperative period. The transient nature of this obstruction, which was managed by a temporary percutaneous nephrostomy, indicates that it was caused by ureteric compression secondary to soft tissue oedema following surgery. We highlight the importance of this potential complication in females with a history of nephrectomy, unilateral renal tract anomalies or severely diminished renal reserve.

scholarly journals Meningiomas of pineal region in children

2007 ◽  
Vol 65 (4a) ◽  
pp. 1000-1006 ◽  
Author(s):  
Hamilton Matushita ◽  
Fernando Campos Pinto ◽  
José Píndaro Pereira Plese
Keyword(s):  
Clinical Presentation ◽  
Complete Removal ◽  
Pineal Region ◽  
Total Resection ◽  
Long Term Follow Up ◽  
One Year ◽  
Velum Interpositum ◽  
Transtentorial Approach

Meningiomas are uncommon tumors in children and either more rarely encountered in the pineal region. We report two cases of meningioma of the pineal region in children. One of these cases was a five years-old girl and the other a one year-old boy. No specific clinical presentation or tomographic examinations findings was identified before treatment, suggestive of a diagnosis of menigioma. The clinical and laboratory features were very similar to the most common tumors of the pineal region. Prior to the surgery, the histology of these tumors was not suspected. Both patients underwent direct surgery and complete removal was achieved by a suboccipital transtentorial approach. The tumors originated from velum interpositum in both cases. At the follow up, one case presented with recurrence six years later, and she underwent a reoperation with total resection without morbidity. Long-term follow up presented no other recurrences.

Endoscopic Transnasal Resection of Ectopic Esthesioneuroblastoma in the Pterygopalatine Fossa: Technical Case Report

2009 ◽  
Vol 65 (suppl_6) ◽  
pp. onsE112-onsE113 ◽  
Author(s):  
Satoru Kodama ◽  
Toshiaki Kawano ◽  
Masashi Suzuki
Keyword(s):  
Clinical Presentation ◽  
Malignant Tumors ◽  
Malignant Neoplasm ◽  
Complete Removal ◽  
Pterygopalatine Fossa ◽  
Open Approach ◽  
Transnasal Approach ◽  
Olfactory Neuroepithelium ◽  
Endoscopic Transnasal Approach ◽  
Left Maxillary Sinus

Abstract Objective: Esthesioneuroblastoma is a rare, malignant neoplasm arising from the olfactory neuroepithelium in the upper nasal cavity. Even more rare is ectopic esthesioneuroblastoma developing from the region outside the olfactory epithelium. In addition, tumors occurring in the pterygopalatine fossa (PPF) are uncommon, and the endoscopic transnasal approach for the resection of malignant tumors in this region is also uncommon. Clinical Presentation: We describe an esthesioneuroblastoma arising from the left maxillary sinus and PPF. The tumor was resected using the endoscopic transnasal approach, followed by treatment with radiotherapy. The patient showed no evidence of recurrence 12 months postoperatively. Technique: The endoscopic transnasal approach could be successfully used for the complete removal of malignant tumors in the PPF. Conclusion: The PPF is an anatomic area that is difficult to access. The endoscopic transnasal approach improves access and visualization; it also has the potential to reduce complications compared with the open approach. The endoscopic transnasal approach might become the treatment of choice for malignant tumors in the PPF.

scholarly journals Pregnancy after tension-free vaginal mesh (anterior Prolift) and concomitant tension-free vaginal tape-obturator procedure

2011 ◽  
Vol 25 (1) ◽  
pp. 17
Author(s):  
Xiao Luo ◽  
Li Xiao Wan ◽  
Hong Shen ◽  
Yin Xiu Xia ◽  
Chao Han Zhang ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Young Patients ◽  
Pelvic Organ ◽  
Vaginal Wall ◽  
Vaginal Mesh ◽  
Pelvic Floor Reconstruction ◽  
Tension Free ◽  
Tension Free Vaginal Tape ◽  
History Of ◽  
Vaginal Tape Obturator

<em>Objective</em>. Treatment of anterior vaginal wall prolapse and stress urinary incontinence (SUI) with transobturator tension-free vaginal mesh (anterior Prolift) and concomitant tension-free vaginal tape-obturator (TVT-O) has been proved feasible, safe and effective. However, there is little known about the influence of pregnancy on women who have had such procedures before pregnancy. <em>Design and methods.</em> A 32-year-old woman (gravid 1, para 1) with two years history of SUI and nine months history of pelvic organ prolapse (POP) was treated with transobturator tension-free vaginal mesh (anterior Prolift) and concomitant TVT-O. Her recovery was excellent, and she was pregnant eight months after the operation. <em>Results</em>. The patient went through her pregnancy smoothly with no special discomfort and successfully delivered an infant via caesarean section without recurrence of POP and SUI. Her last visit to our clinic about 14 months after caesarean section revealed that the anterior Prolift mesh and TVT-O mesh still remained intact and the position of the vaginal fornix, anterior and posterior walls and uterus also remained normal. <em>Conclusions</em>: Pelvic floor reconstruction with vaginal mesh (Prolift) may have positive significance for young patients who desire uterine preservation for future pregnancies. However, further studies are warranted to determine whether it can be used in pregnant women or women planning future pregnancies.

Comparative Study of Three Surgical Treatments for Two Forms of the Clinical Presentation of Bovine Pododermatitis

2004 ◽  
Vol 1026 (1) ◽  
pp. 118-124 ◽  
Author(s):  
L A F SILVA ◽  
I B ATAYDE ◽  
M C S FIORAVANTI ◽  
D EURIDES ◽  
K S OLIVEIRA ◽  
...  
Keyword(s):  
Comparative Study ◽  
Clinical Presentation ◽  
Surgical Treatments

scholarly journals Significant Improvement in Quality of Life, Positive Effect on Sexuality, Lasting Reconstructive Result and Low Rate of Complications Following Cystocele Correction Using a Lightweight, Large-Pore, Titanised Polypropylene Mesh

2019 ◽  
Vol 79 (09) ◽  
pp. 959-968 ◽  
Author(s):  
Tina Cadenbach-Blome ◽  
Markus Grebe ◽  
Mathias Mengel ◽  
Friedrich Pauli ◽  
Angelika Greser ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Multicentre Study ◽  
Pelvic Floor ◽  
Polypropylene Mesh ◽  
Pelvic Organ ◽  
Wilcoxon Test ◽  
Pelvic Floor Reconstruction ◽  
Stable Reconstruction ◽  
Alloplastic Mesh

Abstract Introduction Patients who suffer from pelvic organ prolapse can experience severe limitations in their quality of life. To improve the quality of life of women affected and achieve a stable reconstruction, surgical therapy is often indispensable. In conventional prolapse surgery, the rate of recurrence is high. For this reason, alloplastic mesh has been implanted increasingly in recent years to reconstruct the anatomy of the pelvic floor organs. Even if the anatomical result can be significantly improved as a result, the mesh-induced complications have been the subject of controversial discussion. In this national, multicentre study, the quality of life, anatomical result as well as the rate of complications following the implantation of an alloplastic mesh for the correction of a cystocele were investigated. Method Fifty-four patients with symptomatic ≥ grade II were included in this prospective, national, multicentre study. The study participants were implanted with a titanised polypropylene mesh (TiLOOP® PRO A, pfm medical ag). The follow-up observation period was 12 months. Primary as well as repeat procedures were taken into account. The anatomic result of the pelvic floor reconstruction was quantified using the POP-Q system. Data on quality of life and sexuality were collected using validated questionnaires. All complications which occurred were documented and evaluated by an independent committee. Results On average, the patients were in line with the census. An improvement in quality of life was able to be determined during the study in all domains investigated (p < 0.001, Wilcoxon test). Minus incorrect entries and incorrect reports, a total of 19 reports of adverse events in 15 patients were evaluated by the end of the study. The rate of recurrence in the anterior compartment was 4.3%. Conclusion In the reconstruction of the anatomical position of the pelvic floor organs given the presence of a symptomatic cystocele, the implantation of a third-generation alloplastic mesh achieves very good results. Affected patients benefit from the anatomical stability as well as a significant improvement in quality of life, whereby the risks are justifiable.

scholarly journals Impact of diagnostic delay to the clinical presentation and associated factors in pediatric inflammatory bowel disease: a retrospective study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Emmiina Sulkanen ◽  
Marleena Repo ◽  
Heini Huhtala ◽  
Pauliina Hiltunen ◽  
Kalle Kurppa
Keyword(s):  
Inflammatory Bowel Disease ◽  
Abdominal Pain ◽  
Bowel Disease ◽  
Clinical Presentation ◽  
Diagnostic Delay ◽  
Good Prognosis ◽  
Pediatric Inflammatory Bowel Disease ◽  
Tertiary Center ◽  
Inflammatory Bowel ◽  
Bloody Stools

Abstract Background Undelayed diagnosis is thought to be a major determinant for good prognosis in pediatric inflammatory bowel disease (PIBD). However, factors predicting diagnostic delay and the consequences of this remain poorly defined. We investigated these issues in a well-defined cohort of PIBD patients. Methods Comprehensive electronic data were collected from 136 PIBD patients retrospectively. Diagnostic delay was further classified into < 6 and ≥ 6 months, and < 12 and ≥ 12 months. Logistic regression was used to calculate whether the delay was associated with clinical features and/or risk of complications and co-morbidities at diagnosis. Results The median age of patients was 12.4 years and 43.4% were females. Altogether 35.5% had Crohn´s disease (CD), 59.1% ulcerative colitis (UC) and 6.6% IBD undefined (IBD-U). The median delay before diagnosis was 5.0 months in all, 6.6 months in CD, 4.1 months in UC, and 9.8 months in IBD-U (UC vs. CD, p = 0.010). In all but IBD-U most of the delay occurred before tertiary center referral. Abdominal pain predicted a delay > 6 months in all PIBD (OR 2.07, 95% CI 1.00–4.31) and in UC patients (3.15, 1.14–8.7), while bloody stools predicted a shorter delay in all PIBD (0.28, 0.14–0.59) patients and in CD (0.10, 0.03–0.41) patients. A delay > 6 months was associated with a higher frequency of complications (2.28, 1.01–5.19). Conclusions Delay occurred mostly before specialist consultation, was longer in children presenting with abdominal pain and in CD and was associated with risk of complications. These findings emphasize the roles of active case-finding and prompt diagnostic evaluations.

Sign in / Sign up

Export Citation Format

Share Document