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.

Four Month and One Year Results of Transvaginal Mesh Placement (Prolift Procedure) in the Treatment of Pelvic Organ Prolapse

2009 ◽  
Vol 16 (6) ◽  
pp. S45
Author(s):  
N. Ehsani ◽  
H. Van Raalte ◽  
S. Molden ◽  
V. Lucente ◽  
M. Murphy ◽  
...  
Keyword(s):  
Pelvic Organ Prolapse ◽  
Pelvic Organ ◽  
Transvaginal Mesh ◽  
Mesh Placement ◽  
One Year

scholarly journals Pelvic organ prolapse surgical training program in Bangladesh and Nepal improves objective patient outcomes

2020 ◽  
Author(s):  
Barbara Hall ◽  
Judith Goh ◽  
Maqsudul Islam ◽  
Anubha Rawat
Keyword(s):  
Pelvic Organ Prolapse ◽  
Training Program ◽  
Patient Outcomes ◽  
Surgical Training ◽  
Pelvic Organ ◽  
Vaginal Repair ◽  
Low Resource ◽  
Prolapse Recurrence ◽  
Surgical Training Program

Abstract Introduction and hypothesis The DAK Foundation (Sydney) has facilitated pelvic organ prolapse (POP) repairs performed by local gynecologists for underprivileged women in Bangladesh and Nepal since 2014. Initially, there was no long-term patient follow-up. When 156 patients were examined at least 6 months after their surgery, an unacceptably high rate of prolapse recurrence and shortened vaginas was identified. This demonstrated the need for surgical up-skilling in both countries. Our hypothesis is that the introduction of a surgical training program in low-resource countries can significantly improve patient outcomes after pelvic floor surgery. Methods One-on-one surgical re-training was undertaken to up-skill the gynecologists in fascial vaginal repair and vaginal apical reconstruction utilizing sacrospinous fixation (SSF). Following the surgical up-skilling, a further 289 women (between 6 and 18 months post-operatively) were examined to determine patient outcomes. Outcome measures were: Prolapse recurrence: POPQ (pelvic organ prolapse quantification [1]) ≥ stage 2 Vaginal length < 4 cm Results Prior to implementation of the surgical training program, 76% of patients had recurrent prolapse ≥ stage 2, and 56% had a vagina < 4 cm in length. Following the training program, prolapse recurrence was reduced to 45% with significant reductions in the apical, anterior and posterior compartments. The incidence of unacceptable vaginal shortening was 4%. We could not rely on patient symptoms to determine whether they had recurrences. Conclusion Clinical patient follow-up to determine surgical outcome is essential in low-resource settings. We have demonstrated that surgical up-skilling in vaginal hysterectomy, vaginal repair and introduction of SSF were necessary to achieve acceptable prolapse recurrence rates in our programs in Bangladesh and Nepal.

scholarly journals Novel Hybrid Mesh Surgery Combines Sacrocolpopexy with Transvaginal Mesh Placement for Pelvic Organ Prolapse

2011 ◽  
Vol 78 (6) ◽  
pp. 379-383 ◽  
Author(s):  
Masao Ichikawa ◽  
Shigeo Akira ◽  
Katsuya Mine ◽  
Nozomi Ohuchi ◽  
Nao Iwasaki ◽  
...  
Keyword(s):  
Pelvic Organ Prolapse ◽  
Pelvic Organ ◽  
Transvaginal Mesh ◽  
Hybrid Mesh ◽  
Mesh Placement ◽  
Mesh Surgery

scholarly journals The mesh controversy

F1000Research ◽  
2016 ◽  
Vol 5 ◽  
pp. 2423 ◽  
Author(s):  
Joshua A. Cohn ◽  
Elizabeth Timbrook Brown ◽  
Casey G. Kowalik ◽  
Melissa R. Kaufman ◽  
Roger R. Dmochowski ◽  
...  
Keyword(s):  
Urinary Incontinence ◽  
Pelvic Organ Prolapse ◽  
Stress Urinary Incontinence ◽  
Pelvic Organ ◽  
Transvaginal Mesh ◽  
Class Iii ◽  
Regulatory Oversight ◽  
Mesh Placement ◽  
Recent Developments ◽  
Uncertain Future

Pelvic organ prolapse and stress urinary incontinence are common conditions for which approximately 11% of women will undergo surgical intervention in their lifetime. The use of vaginal mesh for pelvic organ prolapse and stress urinary incontinence rose rapidly in the early 2000s as over 100 mesh products were introduced into the clinical armamentarium with little regulatory oversight for their use. US Food and Drug Administration Public Health Notifications in 2008 and 2011, as well as reclassification of transvaginal mesh for prolapse to class III in early 2016, were a response to debilitating complications associated with transvaginal mesh placement in many women. The midurethral sling has not been subject to the same reclassification and continues to be endorsed as the “gold standard” for surgical management of stress urinary incontinence by subspecialty societies. However, litigators have not differentiated between mesh for prolapse and mesh for incontinence. As such, all mesh, including that placed for stress urinary incontinence, faces continued controversy amidst an uncertain future. In this article, we review the background of the mesh controversy, recent developments, and the anticipated role of mesh in surgery for prolapse and stress urinary incontinence going forward.

Risk factors for stress urinary incontinence after native-tissue vaginal repair of pelvic organ prolapse

2018 ◽  
Vol 141 (3) ◽  
pp. 349-353 ◽  
Author(s):  
Matteo Frigerio ◽  
Stefano Manodoro ◽  
Stefania Palmieri ◽  
Federico Spelzini ◽  
Rodolfo Milani
Keyword(s):  
Risk Factors ◽  
Urinary Incontinence ◽  
Pelvic Organ Prolapse ◽  
Stress Urinary Incontinence ◽  
Pelvic Organ ◽  
Vaginal Repair ◽  
Native Tissue

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

Native-Tissue Anterior Colporrhaphy Versus Transvaginal Mesh for Anterior Pelvic Organ Prolapse

2021 ◽  
pp. 191-196
Author(s):  
Nick Rockefeller ◽  
Peter Jeppson
Keyword(s):  
Pelvic Organ Prolapse ◽  
Clinical Case ◽  
Pelvic Organ ◽  
Vaginal Wall ◽  
Anterior Vaginal Wall ◽  
Anterior Colporrhaphy ◽  
Transvaginal Mesh ◽  
Anterior Vaginal Wall Prolapse ◽  
Native Tissue ◽  
Landmark Study

This article provides a summary of a landmark study in the management of pelvic organ prolapse. This study sought to evaluate if patients with anterior vaginal wall prolapse should be managed with a traditional native tissue colporrhaphy or with transvaginal mesh. This article briefly reviews other relevant studies related to vaginal prolapse and concludes with a relevant clinical case.

scholarly journals Transvaginal mesh repair of anterior enterocele following radical cystectomy and ileal conduit diversion

2019 ◽  
Vol 31 (1) ◽  
Author(s):  
Jose Daniel Roman
Keyword(s):  
Radical Cystectomy ◽  
Mesh Repair ◽  
Ileal Conduit ◽  
Pelvic Organ ◽  
Transvaginal Mesh ◽  
Vaginal Repair ◽  
Endopelvic Fascia ◽  
Prolapse Recurrence ◽  
Anterior Enterocele ◽  
Transvaginal Mesh Repair

Complex pelvic organ prolapses may develop after radical cystectomy. We report a case of an anterior enterocele, which was repaired vaginally and using mesh placed extraperitoneally. We present the case of a 75-year-old woman who underwent a radical cystectomy and ileal conduit diversion for treatment of invasive bladder cancer. She developed a vaginal vault prolapse 4 months later. She then underwent a vaginal repair and sacrospinous fixation using no mesh. She then presented to our clinic 4 months later with a prolapse recurrence involving an anterior enterocele. She was treated successfully with a transvaginal mesh repair for reconstruction of the anterior vaginal wall, iliococcygeal suspension and colpocliesis. We argue that there is a place for the vaginal use of mesh in the surgical treatment of an anterior enterocele when a substantial loss of endopelvic fascia is encountered. The extraperitoneal technique seems to be a good option while reducing the surgical risks for the patient.

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