Mesh Erosion After Abdominal Sacral Colpopexy
ABSTRACT Background: Abdominal sacral colpopexy is an important operation in managing posthysterectomy vaginal vault prolapse and total uterine procidentia. There are few reported series with sufficient patient numbers and duration of follow up that can meaningfully address uncommon complications. Synthetic materials are frequently, and for some operators usually, employed. In this series of 375 abdominal sacral colpopexies during a 23-year interval, 12 patients were encountered who have had mesh erosions through the vaginal mucosa. Mesh erosions were managed in four patients referred to us. One patient in this series had mesh erode into the bladder. It is the purpose of this article to report the management of these patients.
Cases: Fourteen patients were seen principally with the symptom of blood-tinged vaginal discharge, which also may have been malodorous. Three patients were asymptomatic. Examinations revealed either exposed mesh in the upper vagina or in the vaginal sinus tracts. The patient with eroded mesh in her bladder had repetitive bladder infections only. Nine patients underwent successful transvaginal resection of the eroded mesh, and repeat transvaginal resections were performed in seven. The patient with bladder mesh underwent a combined transabdominal/vaginal resection, but she has since had recurrent vesical erosion. A right adnexal complex mass developed in one patient who had had two previous transvaginal resections of eroded mesh. A laparotomy with right salpingo-oophorectomy and a transabdominal resection of her suspensory mesh with removal from the sacrum accompanied by intraoperative hemorrhage were performed.
Conclusions: Synthetic suspensory materials can erode through adjacent tissues and organs. This complication can be managed conservatively in most patients, allowing most of the suspensory material to be left in place and provide continued vaginal support, avoiding potential severe hemorrhage that can result from attempts to remove mesh from the sacrum.
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ABSTRACT: The purpose of this research was to develop and characterize a novel, slowly degrading polyester-urethane. In this study, a polyester-urethane with a crystalline segment of poly((R)-3-hydroxybutyric acid)-diol linked by a diisocyanate to an amorphous segment of poly(epsilon-caprolactone-co-glycolide)-diol was synthesized. Porous and nonporous scaffolds were processed using electrospinning and solvent casting respectively. The morphology, pore size, and filament diameter of the mesh and film were characterized using scanning electron microscopy (SEM). The thermal properties were examined using differential scanning calorimetry (DSC). A degradation study was initiated to characterize the change in mechanical properties, molecular weight, and surface morphology over 12 months using tensile testing, gel permeation chromatography (GPC), and SEM respectively. Concomitantly, cell morphology and viability on these variants were investigated using fibroblasts. The mechanical test data indicated a gradual decrease in the ultimate tensile strength and strain to break while the modulus of elasticity remained stable. GPC data suggested a slow decrease in the molecular weight while SEM examination revealed changed surface morphologies. The in vitro studies implied that the novel polyester-urethane was not cytotoxic and that the mesh was a more favorable scaffold towards cell viability. The summation of these results suggests that this polyester-urethane has the potential for tissue engineering applications.Journal of Biomedical Materials Research Part A 10/2007; 82(3):669-79. · 2.83 Impact Factor
Article: Management of genital prolapse.BMJ (online) 06/2002; 324(7348):1258-62. · 17.22 Impact Factor
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ABSTRACT: To examine short- and long-term mesh-related complications in women undergoing abdominal sacral colpopexy with concurrent hysterectomy, compared with women with a prior hysterectomy undergoing sacral colpopexy alone. Patient characteristics, hospital complications, postoperative clinical course, and long-term graft-related complications were reviewed for all women with genital prolapse who underwent abdominal sacral colopexy between 1996 and 1998. Women with concurrent hysterectomy were compared with women with vaginal prolapse after a prior hysterectomy. One hundred twenty-four patients, 60 with concurrent hysterectomy and 64 with prior hysterectomy, were observed postoperatively for a median of 35.5 (0-74) months. Demographics of the two groups were similar, with a mean age of 65.1 +/- 9.4 years and a mean body mass index of 25.8 +/- 4.2 kg/m(2). Eighty percent of colpopexies used prolene synthetic mesh and 20% allograft material. Initial operative and hospital complications were rare in both groups and included a blood transfusion of 2 U, a ureteral transection, a wound infection, heart block, and an arrhythmia. Delayed graft complications included one mesh erosion in a patient with a prior hysterectomy that was managed by office resection (0.8%). Concurrent hysterectomy with abdominal sacral colopopexy has a low incidence of mesh complications and can be used as a first-line treatment for genital prolapse.Obstetrics and Gynecology 09/2003; 102(2):306-10. · 4.80 Impact Factor