Endoscopic management of transvaginal mesh kit bladder extrusion: A case report and literature review

2020 ◽  
pp. 205141582093719
Author(s):  
Ariel J. Dunn ◽  
Katherine L. Dengler ◽  
Daniel D. Gruber ◽  
David J. Osborn
Keyword(s):  
Pelvic Organ Prolapse ◽  
Rare Complication ◽  
Pelvic Organ ◽  
Transvaginal Mesh ◽  
Endoscopic Management ◽  
Invasive Technique ◽  
Level Of Evidence ◽  
Acute Cystitis ◽  
Prolapse Recurrence ◽  
Mesh Excision

Objective: A rare complication of transvaginal synthetic mesh kits is bladder mesh extrusion. Treatment options include abdominal or vaginal surgical mesh excision or endoscopic mesh vaporization. There are very few published studies detailing endoscopic management. This unique case describes how repeated endoscopic mesh vaporization may be required as mesh extrusion may progress. Methods: A 71-year old female with a history of pelvic organ prolapse managed with an anterior transvaginal mesh kit presented years later with persistent urgency incontinence and recurrent acute cystitis. Cystoscopy eventually revealed bladder calculi adherent to extruded mesh. The stones and extruded mesh were vaporized using the Holmium laser on three occasions over 3 years. Results: Our approach offered a minimally invasive technique with short recovery, no use of a catheter post-operatively and maintained original prolapse repair; however, these patients may be at risk of mesh extrusion recurrence. Conclusion: Bladder extrusion of transvaginal pelvic organ prolapse kit mesh is thankfully a rare complication. With no current consensus for treatment of bladder mesh extrusion, the decision to perform complete mesh excision versus endoscopic treatment should be based on the degree and location of the extrusion, the risk of major complications, mesh extrusion recurrence and the patient’s desired outcomes, including recovery time and risk for prolapse recurrence. Endoscopic vaporization of extruded pelvic organ prolapse mesh likely has a higher recurrence rate than vaginal or abdominal excision. The risks and benefits are important to discuss during counseling and informed consent in these difficult cases. Level of evidence: 4

scholarly journals Serious complications and recurrences after pelvic organ prolapse surgery for 2309 women in the VIGI-MESH registry

2021 ◽  
Author(s):  
Xavier Fritel ◽  
Renaud de Tayrac ◽  
Joe de Keizer ◽  
Sandrine Campagne-Loiseau ◽  
Michel Cosson ◽  
...  
Keyword(s):  
Pelvic Organ Prolapse ◽  
Pelvic Organ ◽  
Transvaginal Mesh ◽  
Vaginal Repair ◽  
Mesh Placement ◽  
Native Tissue ◽  
Prolapse Recurrence ◽  
Pop Surgery ◽  
Laparoscopic Sacropexy ◽  
One Year

Objective: To assess the incidence of serious complications and reoperations for recurrence after pelvic organ prolapse (POP) surgery and compare the three most common types of repair. Design: Prospective cohort study using a registry. Setting: 19 surgical centres in France. Population: 2309 women participated between 2017 and 2019. Methods: a multivariate analysis including an inverse probability of treatment weighting approach was used to obtain three comparable groups. Main outcome measures: Serious complications and subsequent reoperations for POP recurrence Results: Mean follow-up was 16.6 months. Surgeries included in the analysis were native tissue vaginal repair (N=504), transvaginal mesh placement (692), and laparoscopic sacropexy with mesh (1113). Serious complications occurred among 52 women (2.3%), and reoperation for recurrence was required for 32 (1.4%). At one year, the cumulative weighted incidence of serious complications was 1.8% for native tissue vaginal repair (95% confidence interval 0-3.9), 3.9% for transvaginal mesh (2.0-5.9), and 2.2% for sacropexy (1.1-2.6). Compared with the native tissue vaginal repair group, the risk of serious complications was higher in the transvaginal mesh group (weighted-HR 3.84, 2.43-6.08), and the sacropexy group (2.48, 1.45-4.23), while the risk of reoperation for prolapse recurrence was reduced in both groups (transvaginal mesh [0.22, 0.13-0.39] and sacropexy [0.29, 0.18-0.47]). Conclusions: Laparoscopic sacropexy with mesh appears to have a better risk profile (few serious complications and few reoperations for recurrence) than transvaginal mesh placement (more serious complications) and native tissue vaginal repair (more reoperations for recurrence). These results are useful for informing women and for shared decision making.

Laparoscopic sacral colpopexy for pelvic organ prolapse recurrence after transvaginal mesh surgery

2020 ◽  
Vol 248 ◽  
pp. 222-226 ◽  
Author(s):  
Giuseppe Campagna ◽  
Giovanni Panico ◽  
Lorenzo Vacca ◽  
Daniela Caramazza ◽  
Valeria Gallucci ◽  
...  
Keyword(s):  
Pelvic Organ Prolapse ◽  
Pelvic Organ ◽  
Transvaginal Mesh ◽  
Sacral Colpopexy ◽  
Laparoscopic Sacral Colpopexy ◽  
Prolapse Recurrence ◽  
Mesh Surgery

Assessing pelvic organ prolapse recurrence after minimally invasive sacrocolpopexy: does mesh weight matter?

2021 ◽  
Author(s):  
Lauren E. Giugale ◽  
Molly M. Hansbarger ◽  
Amy L. Askew ◽  
Anthony G. Visco ◽  
Jonathan P. Shepherd ◽  
...  
Keyword(s):  
Pelvic Organ Prolapse ◽  
Minimally Invasive ◽  
Pelvic Organ ◽  
Prolapse Recurrence

scholarly journals The efficacy and complications of using transvaginal mesh to treat pelvic organ prolapse in Taiwan: A 10-year review

2021 ◽  
Vol 60 (2) ◽  
pp. 187-192
Author(s):  
Mou-Jong Sun ◽  
Yu-Li Chuang ◽  
Hui-Hsuan Lau ◽  
Tsia-Shu Lo ◽  
Tsung-Hsien Su
Keyword(s):  
Pelvic Organ Prolapse ◽  
Pelvic Organ ◽  
Transvaginal Mesh

scholarly journals Long-term outcomes of transvaginal mesh surgery for pelvic organ prolapse: a retrospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Xiaojuan Wang ◽  
Yisong Chen ◽  
Changdong Hu ◽  
Keqin Hua
Keyword(s):  
Pelvic Organ Prolapse ◽  
Patient Characteristics ◽  
Pelvic Organ ◽  
Transvaginal Mesh ◽  
Recurrence Rates ◽  
Kaplan Meier ◽  
Mesh Surgery ◽  
Patient Global Impression

Abstract Background The objective of this study was to evaluate the overall outcomes and complications of transvaginal mesh (TVM) placement for the management of pelvic organ prolapse (POP) with different meshes with a greater than 10-years of follow-up. Methods We performed a retrospective review of patients with POP who underwent prolapse repair surgery with placement of transvaginal mesh (Prolift kit or self-cut Gynemesh) between January 2005 and December 2010. Baseline of patient characteristics were collected from the patients’ medical records. During follow-up, the anatomical outcomes were evaluated using the POP Quantification system, and the Patient Global Impression of Improvement (PGI-I) was used to assess the response of a condition to therapy. Overall postoperative satisfaction was assessed by the following question: “What is your overall postoperative satisfaction, on a scale from 0 to 10?”. Relapse-free survival was analyzed using Kaplan–Meier curves. Results In total, 134 patients were included. With a median 12-year (range 10–15) follow-up, 52 patients (38.8%) underwent TVM surgery with Prolift, and Gynemesh was used 82 (61.2%). 91% patients felt that POP symptom improved based on the PGI-I scores, and most satisfied after operation. The recurrence rates of anterior, apical and posterior compartment prolapse were 5.2%, 5.2%, and 2.2%, respectively. No significant differences in POP recurrence, mesh-associated complications and urinary incontinence were noted between TVM surgery with Prolift versus Gynemesh. Conclusions Treatment of POP by TVM surgery exhibited long-term effectiveness with acceptable morbidity. The outcomes of the mesh kit were the same as those for self-cutmesh.

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

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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