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Rotem R, Weintruab AY, Padoa A. Bridging present and future: A narrative review and visionary outlook on innovative solutions for the diagnosis and treatment of urinary incontinence. Eur J Obstet Gynecol Reprod Biol 2024; 301:55-59. [PMID: 39094536 DOI: 10.1016/j.ejogrb.2024.07.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Revised: 07/29/2024] [Accepted: 07/30/2024] [Indexed: 08/04/2024]
Abstract
Urinary incontinence, characterized by the involuntary leakage of urine, significantly impacts millions globally, affecting their quality of life, social interactions, and psychological well-being. Traditional diagnostic methods and treatments often fall short, especially for refractory urinary incontinence, due to their invasive nature and limited scope for continuous, real-time assessment. This narrative review critically examines current approaches to diagnosing and managing urinary incontinence, highlights significant gaps in practice, and underscores the urgent need for innovative solutions. We explore the evolution of diagnostic and treatment modalities and introduce a preliminary method involving a conceptual catheter device that promises to shift toward non-invasive, real-time monitoring and management. This review synthesizes prevailing research and provides a visionary outlook on how emerging technologies could revolutionize urinary incontinence care, offering a future of personalized, patient-centered strategies. Our discussion extends to the limitations of conventional urodynamic studies, which are often uncomfortable and fail to capture the dynamic nature of urinary incontinence in everyday settings. The proposed preliminary method features an advanced, smart-device solution integrating sensors and artificial intelligence to offer precise, real-time insights into bladder activity. This device, still in the conceptual stages, has the potential to transform the landscape of urinary incontinence management by enhancing diagnostic accuracy and therapeutic efficacy. By bridging the gap between current limitations and future possibilities, this paper aims to inspire ongoing innovation and research in the field of urogynecology.
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Affiliation(s)
- Reut Rotem
- Department of Urogynaecology, Cork University Maternity Hospital, Cork, Ireland; Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University School of Medicine, Jerusalem, Israel.
| | - Adi Y Weintruab
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Anna Padoa
- Department of Obstetrics and Gynecology, Yitzhak Shamir (Assaf Harofe) Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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2
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Six J, Pinsard M, Guerin S, Gasmi A, Coiffic J, Richard C, Haudebert C, Nyangoh Timoh K, Hascoet J, Peyronnet B. Risk factors for stress urinary incontinence recurrence after midurethral sling revision. Int J Urol 2023; 30:1008-1013. [PMID: 37439555 PMCID: PMC11524087 DOI: 10.1111/iju.15248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 06/27/2023] [Indexed: 07/14/2023]
Abstract
OBJECTIVES The purpose of this study was to report the rate of stress urinary incontinence (SUI) recurrence after sling revision, and to determine predictive factors of SUI recurrence. METHODS We conducted a retrospective cohort study in a single academic center between 2005 and 2022, of patients who underwent sling revision. Four surgical techniques were used for sling revision (loosening, section, partial, and total excision). The primary endpoint was recurrence of SUI at 3 months postoperatively, and the other outcome of interest was the rate of subsequent anti-incontinence surgical procedure. RESULTS Sixty-nine patients were included for analysis. SUI recurred in 46.4% of patients. Fifteen patients underwent a subsequent anti-incontinence procedure (21.8%). The time to revision was significantly longer in the group with recurrent SUI (median: 84.5 vs. 44.8 months; p = 0.004). The recurrence rate differed significantly depending on the revision technique: 7.7% after sling loosening, 22.2% after sling section, 60% after partial excision, and 66.7% after complete sling removal (p = 0.001). The risk of SUI recurrence was lower for those whose indication of reoperation was voiding dysfunction (27.3% vs. 66.7%; p = 0.002), and was higher for those who underwent a trans-obturator tap rather than a tension-free vaginal tape revision (68.4% vs. 35.7%; p = 0.02). In multivariate analysis, only the revision technique remained significantly associated with the risk of recurrence of SUI (complete excision vs. section: odds ratio = 4.66; p = 0.04). CONCLUSION The risk of SUI recurrence may differ widely according to the techniques used, and it seems that the less extensive the surgical procedure is, the lower the risk is.
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Affiliation(s)
- Jeanne‐Claire Six
- Department of Obstetrics, Gynecology and Human ReproductionUniversity of RennesRennesFrance
| | - Marion Pinsard
- Department of Obstetrics, Gynecology and Human ReproductionUniversity of RennesRennesFrance
| | - Sonia Guerin
- Department of Obstetrics, Gynecology and Human ReproductionUniversity of RennesRennesFrance
| | - Anis Gasmi
- Department of UrologyUniversity of RennesRennesFrance
| | - Jerry Coiffic
- Department of Obstetrics, Gynecology and Human ReproductionUniversity of RennesRennesFrance
| | | | | | - Krystel Nyangoh Timoh
- Department of Obstetrics, Gynecology and Human ReproductionUniversity of RennesRennesFrance
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Dibb B, Woodgate F, Taylor L. When things go wrong: experiences of vaginal mesh complications. Int Urogynecol J 2023; 34:1575-1581. [PMID: 36607398 PMCID: PMC10287809 DOI: 10.1007/s00192-022-05422-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 11/14/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Previous research has suggested that complications stemming from vaginal mesh can lead to life-changing negative physical consequences including erosion and chronic pain. However, there has been little research on the experiences of women who have had complications. This study was aimed at exploring the individual experiences of women who have had vaginal mesh complications and how this has impacted them. METHODS An explorative qualitative design was followed. Eighteen semi-structured interviews were conducted with women who had experienced complications with vaginal mesh due to stress urinary incontinence and pelvic organ prolapse. The mean age was 52 and the mean time since the mesh was fitted was 8 years (6 had since had it removed and a further 6 had had partial removal), and the mean time since first mesh-related symptom was 10 months. Data were analysed using thematic analysis. RESULTS Four main themes were identified: perceived impact of mesh complications, attitudes of medical professionals, social support and positive growth. Results showed that participant experiences of their mesh complication were psychologically traumatic, including feelings of increased anxiety and fears relating to suicidal thoughts. Intimate relationships were also affected, with reduced sexual functioning and intimacy stemming from mesh complications. Negative experiences with medical professionals included feeling dismissed, a lack of recognition of their symptoms, and anger towards the profession. CONCLUSIONS The impacts of vaginal mesh complications were found to be wide-reaching and life-changing, affecting numerous aspects of participants' lives. Greater awareness in this area is needed to provide further support for women experiencing vaginal mesh complications.
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Affiliation(s)
- Bridget Dibb
- School of Psychology, University of Surrey, Guildford, Surrey, GU2 7XH, UK.
| | - Fee Woodgate
- School of Psychology, University of Surrey, Guildford, Surrey, GU2 7XH, UK
| | - Lauren Taylor
- School of Psychology, University of Surrey, Guildford, Surrey, GU2 7XH, UK
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Cour F, Munier P, Kaulanjan K, Vidart A, Bosset PO, Neuzillet Y. Small intestinal submucosa xenograft to manage lower urinary tract prostheses perforation: a new path? Int Urogynecol J 2022; 33:627-635. [PMID: 33787953 DOI: 10.1007/s00192-021-04771-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 03/16/2021] [Indexed: 12/01/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Tapes for stress urinary incontinence (SUI) and meshes for pelvic organ prolapse can result in postoperative complications, such as urethral (UP) or bladder (BP) perforations. Martius fat pad (MFP) is an historic procedure, widely used to treat lower urinary tract (LUT) fistulae. We report our experience with the insertion of the biological small intestinal submucosa (SIS) xenograft as an alternative to MFP in these prosthetic complications. METHODS We conducted a retrospective, monocentric study which included all patients who underwent SIS insertion during surgical removal of tape/vaginal mesh for UP or BP from 2011 to 2019. Preoperative assessment was based on history, symptoms, physical examination and urethrocystoscopy. Primary outcome was successful repair defined as absence of any LUT defect. Secondary outcomes were complications, LUT symptoms, pain and additional SUI surgical procedures. RESULTS Thirty-eight patients were included. Twenty-six had a UP and eight a BP. In four cases, perforation involved both the bladder neck and urethra. All LUT defects were cured. Six postoperative complications were reported (five of grade ≤ 2 and one of grade 3b according to the Clavien-Dindo classification). At the mean follow-up of 37.2 (range 6-98) months, 14 patients (36.8%) presenting a postoperative SUI underwent a SUI surgical procedure and 1 patient had a laparoscopic sacrocolpopexy for cystocele recurrence. CONCLUSION Absorbable SIS xenograft is an effective and safe graft for the management of lower urinary tract tape and mesh perforations. The cost has to be balanced with the good results, short operative time and no fat pad complications as in MFP.
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Affiliation(s)
- Florence Cour
- Department of Urology, Foch Hospital, 40 Rue Worth, 92150, Suresnes, France.
| | - Pierre Munier
- Department of Urology, Foch Hospital, 40 Rue Worth, 92150, Suresnes, France
| | - Kevin Kaulanjan
- Department of Urology, Foch Hospital, 40 Rue Worth, 92150, Suresnes, France
| | - Adrien Vidart
- Department of Urology, Foch Hospital, 40 Rue Worth, 92150, Suresnes, France
| | | | - Yann Neuzillet
- Department of Urology, Foch Hospital, 40 Rue Worth, 92150, Suresnes, France
- University of Versailles-Saint-Quentin-en-Yvelines, Versailles, France
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Shapiro R, Dueñas-Garcia OF, Vallejo M, Trump T, Sufficool M, Zaslau S. Recurrent Incontinence After Transvaginal Partial Sling Excision in Patients with Prior Mid-Urethral Sling. Res Rep Urol 2021; 13:9-15. [PMID: 33469519 PMCID: PMC7811473 DOI: 10.2147/rru.s281697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 12/16/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction Patients may develop recurrent urinary tract infections, pain syndromes, dyspareunia, and voiding difficulty after mid-urethral sling placement that can be treated by partial sling excision. Objective The primary objective of this study was to evaluate the incidence of de novo incontinence and voiding difficulty after partial sling excision. A secondary objective was to assess risk factors associated with future incontinence surgery in this subset of patients. Methods From 2009 to 2017, 95 female patients with subjective complaints of pelvic pain, dyspareunia, or voiding difficulty following synthetic mid-urethral sling placement for stress urinary incontinence underwent partial sling excision at a single institution. The incidence of urinary incontinence was assessed 6 months after partial sling excision. Patients were also assessed for resolution of voiding difficulty and future incontinence surgery. Primary endpoints were examined by Pearson's Chi-square test and interval data by t-test. A p < 0.05 was significant. Results About 72% of patients were more likely to be continent after partial sling excision irrespective of initial symptoms prior to surgery. No difference was seen in voiding difficulty between the continent and incontinent patients after partial sling excision (p=0.09). Patients with a retropubic mid-urethral sling were more likely to be continent after partial sling excision (p=0.03). Preoperative maximum flow rate >16 mL/sec was associated as an independent variable to develop incontinence surgery after partial sling excision (p=0.009). Conclusion In conclusion, partial sling excision poses a low risk for de novo urinary incontinence regardless of preoperative symptoms. Stress urinary incontinence may be less likely to reoccur in those patients having a retropubic approach. A preoperative maximum flow rate of >16 mL/sec is a risk factor for future incontinence surgery after partial sling excision and should be taken into consideration when formulating a treatment plan.
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Affiliation(s)
- Robert Shapiro
- Department of Obstetrics & Gynecology, West Virginia University School of Medicine, Morgantown, WV 26506, USA.,Department of Urology, West Virginia University School of Medicine, Morgantown, WV 26506, USA
| | - Omar Felipe Dueñas-Garcia
- Department of Obstetrics & Gynecology, West Virginia University School of Medicine, Morgantown, WV 26506, USA
| | - Manuel Vallejo
- Department of Obstetrics & Gynecology, West Virginia University School of Medicine, Morgantown, WV 26506, USA
| | - Tyler Trump
- Department of Urology, West Virginia University School of Medicine, Morgantown, WV 26506, USA
| | - Makenzy Sufficool
- West Virginia University School of Medicine, Morgantown, WV 26506, USA
| | - Stanley Zaslau
- Department of Obstetrics & Gynecology, West Virginia University School of Medicine, Morgantown, WV 26506, USA.,Department of Urology, West Virginia University School of Medicine, Morgantown, WV 26506, USA
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Sihra N, Kujawa M, Solomon E, Harding C, Sahai A, Malde S. Female stress urinary incontinence MDT. JOURNAL OF CLINICAL UROLOGY 2019. [DOI: 10.1177/2051415818821548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The management of female stress urinary incontinence (SUI) has come under scrutiny in recent years following growing reports of mesh-related complications. Patients require thorough evaluation and management as part of a multidisciplinary team, and extensive counselling about the surgical treatment options is imperative. There is no clear consensus on the optimal management of the complex group of patients with mesh-related complications or recurrent SUI. We present two cases of female SUI to highlight the key factors to be considered when managing these patients. Level of evidence: Level 5.
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Affiliation(s)
- Néha Sihra
- Department of Urology, St George’s Hospital, London, UK
| | - Magda Kujawa
- Department of Urology, Stockport NHS Foundation Trust, Stepping Hill Hospital, UK
| | - Eskinder Solomon
- Department of Urology, Guy’s and St Thomas’ NHS Foundation Trust, Guy’s Hospital, UK
| | | | - Arun Sahai
- Department of Urology, Guy’s and St Thomas’ NHS Foundation Trust, Guy’s Hospital, UK
| | - Sachin Malde
- Department of Urology, Guy’s and St Thomas’ NHS Foundation Trust, Guy’s Hospital, UK
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Mahdy A, Ghoniem GM. Autologous rectus fascia sling for treatment of stress urinary incontinence in women: A review of the literature. Neurourol Urodyn 2018; 38 Suppl 4:S51-S58. [PMID: 30525246 DOI: 10.1002/nau.23878] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 10/06/2018] [Indexed: 11/12/2022]
Abstract
AIMS Stress urinary incontinence (SUI) is common in the adult females. Surgical treatment options include synthetic mid-urethral sling (MUS), autologous sling, bulking agents, and Burch colposuspension. The autologous pubovaginal sling (PVS) has re-emerged in response to complications of synthetic MUSs and FDA communications regarding the use of vaginal mesh. This resulted in patients' fear related to vaginal mesh and drop in number of patients seeking surgical treatment of SUI. PVS has re-emerged as an option for treatment of primary SUI. The aim of this review is to familiarize, disseminate information, and share tips for the practicing female pelvic surgeons related to the practice of the autologous fascia sling. METHODS We reviewed the literature related to the autologous sling. We used the following data bases and search engines: GoPubMed (Transinsight), Cochrane reviews (Wiley Interscience), google scholar (google), and Scopus (Elsevier). Because it is the most commonly investigated and utilized, we focused on the autologous rectus fascia sling. We also focused on the retropubic sling approach because the literature on transobturator rectus fascia sling is sparse. RESULTS Out of 307 articles related to the subject found, 22 articles were included and the rest were excluded. CONCLUSION ARFS is a valid primary method of treatment for female SUI. Also, it is used in particular indications such as patients with intrinsic sphincter deficiency (ISD), prior pelvic irradiation, failed and/or complicated synthetic MUS, and violated urethral lumen.
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Affiliation(s)
- Ayman Mahdy
- Department of Urology, University of Cincinnati, Cincinnati, Ohio
| | - Gamal M Ghoniem
- Chief Division of Female Urology, Pelvic Reconstructive Surgery & Voiding Dysfunction, Department of Urology
- UC Irvine Health, Orange, California
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8
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Ismail S, Chartier-Kastler E, Reus C, Cohen J, Seisen T, Phé V. Functional outcomes of synthetic tape and mesh revision surgeries: a monocentric experience. Int Urogynecol J 2018; 30:805-813. [DOI: 10.1007/s00192-018-3727-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 07/17/2018] [Indexed: 10/28/2022]
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9
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Current Role of Urethrolysis and Partial Excision in Patients Seeking Revision of Anti-Incontinence Sling. Female Pelvic Med Reconstr Surg 2018; 25:409-414. [DOI: 10.1097/spv.0000000000000596] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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10
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MacDonald S, Terlecki R, Costantini E, Badlani G. Complications of Transvaginal Mesh for Pelvic Organ Prolapse and Stress Urinary Incontinence: Tips for Prevention, Recognition, and Management. Eur Urol Focus 2016; 2:260-267. [DOI: 10.1016/j.euf.2016.06.016] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 06/28/2016] [Accepted: 06/30/2016] [Indexed: 10/21/2022]
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Re: Management of Complications of Mesh Surgery. J Urol 2016; 195:1539-1543. [PMID: 27186749 DOI: 10.1016/j.juro.2016.02.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2016] [Indexed: 11/21/2022]
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Cohen SA, Raz S. Use of synthetic grafts in pelvic reconstruction: A path of continued discovery. World J Clin Urol 2016; 5:11-17. [DOI: 10.5410/wjcu.v5.i1.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 01/11/2016] [Accepted: 02/16/2016] [Indexed: 02/06/2023] Open
Abstract
Since the 1990s, mesh has been used in pelvic reconstruction to augment repairs for stress urinary incontinence and pelvic organ prolapse (POP). In 2008 and 2011, the United States Food and Drug Administration (FDA) issued Public Health Notifications ultimately informing providers and the public that complications associated with the use of synthetic mesh in the transvaginal repair of POP are not rare. In this review, we (1) examine literature characterizing surgical practice-patterns subsequent to the FDA announcements; (2) describe presentation of mesh-associated complications and outcomes of management; (3) discuss the most recent materials science research; and (4) seek to characterize whether or not mesh has lived up to the long-term efficacy promise of a permanent implant. Durability of mesh-augmented anatomical outcomes do not consistently translate into improved patient satisfaction and subjective outcomes. This, when coupled with the possibility of mesh-associated complications, emphasizes the need for continued innovation beyond the status quo of current synthetic grafts.
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McCoy O, Vaughan T, Nickles SW, Ashley M, MacLachlan LS, Ginsberg D, Rovner E. Outcomes of Autologous Fascia Pubovaginal Sling for Patients with Transvaginal Mesh Related Complications Requiring Mesh Removal. J Urol 2016; 196:484-9. [PMID: 26997314 DOI: 10.1016/j.juro.2016.02.2976] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2016] [Indexed: 11/27/2022]
Abstract
PURPOSE We reviewed the outcomes of the autologous fascial pubovaginal sling as a salvage procedure for recurrent stress incontinence after intervention for polypropylene mesh erosion/exposure and/or bladder outlet obstruction in patients treated with prior transvaginal synthetic mesh for stress urinary incontinence. MATERIALS AND METHODS In a review of surgical databases at 2 institutions between January 2007 and June 2013 we identified 46 patients who underwent autologous fascial pubovaginal sling following removal of transvaginal synthetic mesh in simultaneous or staged fashion. This cohort of patients was evaluated for outcomes, including subjective and objective success, change in quality of life and complications between those who underwent staged vs concomitant synthetic mesh removal with autologous fascial pubovaginal sling placement. RESULTS All 46 patients had received at least 1 prior mesh sling for incontinence and 8 (17%) had received prior transvaginal polypropylene mesh for pelvic organ prolapse repair. A total of 30 patients underwent concomitant mesh incision with or without partial excision and autologous sling placement while 16 underwent staged autologous sling placement. Mean followup was 16 months. Of the patients 22% required a mean of 1.8 subsequent interventions an average of 6.5 months after autologous sling placement with no difference in median quality of life at final followup. At last followup 42 of 46 patients (91%) and 35 of 46 (76%) had achieved objective and subjective success, respectively. There was no difference in subjective success between patients treated with a staged vs a concomitant approach (69% vs 80%, p = 0.48). CONCLUSIONS Autologous fascial pubovaginal sling placement after synthetic mesh removal can be performed successfully in patients with stress urinary incontinence as a single or staged procedure.
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Affiliation(s)
- Olugbemisola McCoy
- Department of Urology, Medical University of South Carolina, Charleston, South Carolina
| | - Taylor Vaughan
- Department of Urology, Medical University of South Carolina, Charleston, South Carolina
| | - S Walker Nickles
- Department of Urology, Medical University of South Carolina, Charleston, South Carolina
| | - Matt Ashley
- Department of Urology, University of Southern California, Los Angeles, California
| | | | - David Ginsberg
- Department of Urology, University of Southern California, Los Angeles, California
| | - Eric Rovner
- Department of Urology, Medical University of South Carolina, Charleston, South Carolina.
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Abstract
PURPOSE OF REVIEW Transvaginal placements of synthetic mid-urethral slings and vaginal meshes have largely superseded traditional tissue repairs in the current era because of presumed efficacy and ease of implant with device 'kits'. The use of synthetic material has generated novel complications including mesh extrusion, pelvic and vaginal pain and mesh contraction. In this review, our aim is to discuss the management, surgical techniques and outcomes associated with mesh removal. RECENT FINDINGS Recent publications have seen an increase in presentation of these mesh-related complications, and reports from multiple tertiary centers have suggested that not all patients benefit from surgical intervention. SUMMARY Although the true incidence of mesh complications is unknown, recent publications can serve to guide physicians and inform patients of the surgical outcomes from mesh-related complications. In addition, the literature highlights the growing need for a registry to account for a more accurate reporting of these events and to counsel patients on the risk and benefits before proceeding with mesh surgeries.
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Blaivas JG, Purohit RS, Benedon MS, Mekel G, Stern M, Billah M, Olugbade K, Bendavid R, Iakovlev V. Safety considerations for synthetic sling surgery. Nat Rev Urol 2015; 12:481-509. [DOI: 10.1038/nrurol.2015.183] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Blaivas JG. Synthetic Sling for Index Patients with Stress Urinary Incontinence. J Urol 2015; 194:19-20. [DOI: 10.1016/j.juro.2015.04.067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Indexed: 11/25/2022]
Affiliation(s)
- Jerry G. Blaivas
- Department of Urology, Weill Medical College of Cornell University, New York, New York
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Management of Mesh Complications after SUI and POP Repair: Review and Analysis of the Current Literature. BIOMED RESEARCH INTERNATIONAL 2015; 2015:831285. [PMID: 25973425 PMCID: PMC4418012 DOI: 10.1155/2015/831285] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 10/31/2014] [Indexed: 11/22/2022]
Abstract
Purpose. To evaluate the surgical treatment concepts for the complications related to the implantation of mesh material for urogynecological indications. Materials and Methods. A review of the current literature on PubMed was performed. Results. Only retrospective studies were detected. The rate of mesh-related complications is about 15–25% and mesh erosion is up to 10% for POP and SUI repair. Mesh explantation is necessary in about 1-2% of patients due to complications. The initial approach appears to be an early surgical treatment with partial or complete mesh resection. Vaginal and endoscopic access for mesh resection is favored. Prior to recurrent surgeries, a careful examination and planning for the operation strategy are crucial. Conclusions. The data on the management of mesh complication is scarce. Revisions should be performed by an experienced surgeon and a proper follow-up with prospective documentation is essential for a good outcome.
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Rovner ES. Progress in Stress Incontinence Surgery—Are We Destined to Fail? J Urol 2015; 193:758-9. [DOI: 10.1016/j.juro.2014.12.067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Eric S. Rovner
- Department of Urology, Medical University of South Carolina, Charleston, South Carolina
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Abstract
OBJECTIVES The objectives of this study are (1) to describe the presenting symptoms, findings, and treatment and (2) to describe the self-reported improvement and function at least 6 months after presentation in women presenting to 1 urogynecology division for complications associated with synthetic vaginal mesh. METHODS Women evaluated between 2006 and 2011 were identified by diagnostic codes. We abstracted information from the medical record and attempted to contact all women to complete a follow-up telephone survey questionnaire consisting of several validated instruments. RESULTS A total of 111 women were evaluated for complications associated with synthetic vaginal mesh. The mean interval from index surgery was 2.4 years. Of these, 84% were referred from outside hospitals. Index surgeries included vaginal mesh kits/vaginally placed mesh (47%), midurethral mesh slings (37%), abdominally placed vaginal mesh (11%), and vaginal mesh kit with concomitantly placed mesh sling (5%). The most common complications were extrusion (65%), contraction (17%), and chronic pelvic pain (16%). A total of 98 women underwent some type of treatment (85 surgical) by urogynecologists, pelvic pain specialists, or physical therapists. Eighty-four (76%) provided follow-up information at mean interval since presentation of 2.3 years. At follow-up, the mean (SD) Pelvic Floor Distress Inventory score was 98 (67), the mean (SD) EQ-5D index score was 0.69 (0.23), and 22% reported vaginal discharge, 15% vaginal bleeding or spotting, and 45% sexual abstinence due to problems related to mesh. A total of 71% reported being overall better, whereas 29% were the same or worse. CONCLUSIONS Two years after tertiary care level multidisciplinary treatment of vaginal mesh complications, many women still report symptoms that negatively impact their quality of life.
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Blaivas JG, Mekel G. Management of Urinary Fistulas Due to Midurethral Sling Surgery. J Urol 2014; 192:1137-42. [DOI: 10.1016/j.juro.2014.04.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Jerry G. Blaivas
- Weill Cornell Medical College, New York, New York
- Institute for Bladder and Prostate Research, New York, New York
| | - Gabriel Mekel
- Institute for Bladder and Prostate Research, New York, New York
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23
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This Month in Adult Urology. J Urol 2013. [DOI: 10.1016/j.juro.2013.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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24
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Weinberger JM, Purohit RS, Blaivas JG. Mesh Infection of a Male Sling. J Urol 2013; 190:1054-5. [DOI: 10.1016/j.juro.2013.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2013] [Indexed: 11/24/2022]
Affiliation(s)
- James M. Weinberger
- Institute for Bladder and Prostate Research, Weill Medical College of Cornell University, New York, New York
| | - Rajveer S. Purohit
- Institute for Bladder and Prostate Research, Weill Medical College of Cornell University, New York, New York
| | - Jerry G. Blaivas
- Institute for Bladder and Prostate Research, Weill Medical College of Cornell University, New York, New York
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