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: To estimate the incidence of mesh-related complications including mesh erosion/extrusion rates in patients undergoing laparoscopic sacral colpopexy, with or without concurrent hysterectomy, using macroporous soft polypropylene mesh. Historical cohort study (Canadian Task Force classification II-2). Private urogynecology clinic. A total of 446 consecutive patients with uterovaginal or vaginal vault prolapse underwent laparoscopic sacral colpopexy with use of macroporous soft polypropylene mesh from January 2003 through January 2007. In all, 402 consecutive patients met enrollment criteria. Two groups of patients were identified: (1) those receiving concurrent hysterectomy (n = 130); and (2) those with a history of hysterectomy (n = 272). Patients were treated with laparoscopic sacral colpopexy with use of macroporous soft polypropylene mesh in conjunction with other laparoscopic and/or vaginal procedures. Data were collected in the form of chart reviews and patient questionnaires. Comparisons were made between groups 1 and 2. Patient demographics, history, mesh erosion/extrusion rates, and mesh-related complications were analyzed. Length of follow-up was 1 to 54 months with a median follow-up time of 12 months. No statistically significant differences existed between 2 groups in rates of mesh erosion/extrusion or other mesh-related complications. Overall vaginal mesh erosion/extrusion rate was 1.2% (95% CI 0.5%-2.7%) with an associated mesh revision rate of 1.2% (95% CI 0.5%-2.7%). Patients with concurrent hysterectomy had an erosion/extrusion rate of 2.3% (3/130) as compared with 0.7% (2/272) in patients with a history of hysterectomy, p = .18. No cases of mesh erosion through organs and tissues other than vaginal mucosa were observed. Cuff abscess occurred in 1 patient with concurrent hysterectomy, with an overall infection rate of 0.3% (95% CI 0.01%-1.2%). One more patient developed an inflammatory reaction to the mesh. Excision of exposed mesh was performed in all 5 patients with mesh extrusion. Vaginal approach to excision was uniformly used. Laparoscopic removal of the entire mesh took place in 4 patients with persistent pelvic pain, in 1 patient with cuff abscess, and in one patient with a questionable mesh reaction. An estimated 975 to 17 000 patients were required in each group to achieve power to detect a statistically significant difference in rate of mesh-related complications in this study. Risk of mesh extrusion or other mesh-related complications after laparoscopic sacral colpopexy using soft macroporous Y-shaped polypropylene mesh is about 1% in our study. No significant increase in risk of mesh-related complications was observed in patients receiving concurrent hysterectomy when compared with patients who had a previous hysterectomy. The sample size of almost 2000 patients was needed to detect a statistically significant difference in rate of mesh-extrusion in this study.Journal of Minimally Invasive Gynecology 01/2008; 15(2):188-96. · 1.61 Impact Factor
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ABSTRACT: This study looked at the subjective and objective long-term outcome of abdominal sacrocolpopexy for post-hysterectomy vaginal vault prolapse, with emphasis on recurrent prolapse. It included 42 patients who had abdominal sacrocolpopexy for post-hysterectomy vaginal vault prolapse from 1994 to 2004. Patients were invited for a follow-up visit to assess the objective and subjective outcome. The notes of 35 patients (83.3%) were available and 22 attended for follow-up (52.4%). None of them had a recurrent vault prolapse (0% direct failure rate). However, 20 cases (20%) had a repair operation by the time they were invited for follow-up and 18 of those attending for follow-up had anterior and/or posterior vaginal wall prolapse (81.8% indirect failure rate). Nonetheless, only eight of these (44.4%) were symptomatic, bringing the rate of indirect recurrences requiring management to 50%. Concomitant or prior repair operation was associated with a lower incidence of indirect recurrence. The incidence of urodynamic stress incontinence and detrusor overactivity was 13.6% and bowel emptying dysfunction was 4.5%.Journal of Obstetrics and Gynaecology 05/2007; 27(3):292-6. · 0.55 Impact Factor
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ABSTRACT: TREATMENT OF POST-SURGICAL COMPLICATIONS ANTIINCONTINENCE WITH "SLING" Reports on postoperative complications of anti-incontinence surgery followed the widespread use of synt- hetic slings. In this paper we describe the more frequent complications, such as obstruction, pelvic hema- toma, bladder and urethral injuries, to facilitate the management of these complications.Actas Urologicas Espanolas - ACTAS UROL ESP. 01/2008; 32(7).