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Mesh was a promising, minimally invasive, and ‘gold standard’ treatment for urinary stress incontinence. Time has shown that complications from these devices can happen early, or even several years, after mesh placement and can be catastrophic. Pain, erosion, voiding dysfunction, infection, recurrent UTIs [urinary tract infections (UTIs)], fistulae...
Citations
... 26,27,32 However, multiple publications describe mesh complications (e.g., pain, erosion, voiding dysfunction, infection, recurrent urinary tract infections, fistulae, organ perforation, bleeding vaginal scarring, neuromuscular alterations, LUTS, bowel complications, and immune disorders). [62][63][64][65] A study showed that 42% of women had at least one adverse event, and 12% had at least one serious adverse event. 66 A systematic review showed that using polypropylene pelvic mesh becomes highly controversial because of serious complications provoked by an essential mismatch between its viscoelastic properties and the structure of the surrounding tissue. ...
... However, most published studies have been too heterogenous, usually consisting of female patients with every kind of mesh-related complication. 3,4,9,10,23 It is logical to perform total mesh removal in patients with pain, present study demonstrated that the risk of de novo SUI in patients with unilateral J-cut division surgery was significantly lower than in those with partial and subtotal vaginal removal surgery. 6,7,9,10 Persistence of storage symptoms and UUI after SRS may often be troublesome. ...
... No urethral injury occurred in the patients who had either the unilateral J-cut division or the subtotal vaginal removal surgery in which the sling was divided laterally. Future studies with a larger number of patients comparing the unilateral and midline division techniques in patients with MRUO are needed to determine the most favourable technique regarding the urethral injury complication.The terminology of the SRS techniques such as the division, partial, subtotal and total removal of mesh must be clearly defined and standardized to compare the efficacy and complications of the different techniques of SRS.4,25,26 In the present study, the mesh division involved only cutting the mesh unilaterally without removing any part of it, while the partial and subtotal vaginal removal consisted of varying degrees of segmental removal of the mesh with a vaginal midline or lateral approaches. ...
Objective
To compare the functional (obstruction relieving) outcomes and complications of unilateral J‐cut division, partial and subtotal vaginal removal techniques were performed for mesh‐related urethral obstruction (MRUO) in females.
Methods
Patient review included demographics, a medical history and proforma with details of lower urinary tract symptoms (LUTS), physical and urodynamic findings, detailed surgical reports and follow‐up data. Variables were compared between the three groups.
Results
Out of 130 patients with sling revision surgery (SRS), 54 women underwent SRS for MRUO with a median follow‐up of 48 (17–96) months. Unilateral J‐cut division, partial and subtotal vaginal removal techniques were performed in 12, 31 and 11 patients with a median duration of surgery of 30 (25–34), 40 (35–56) and 60 (60–70) minutes, respectively (p = 0.001). Statistically significant increase in median maximum free urine flow rate and decrease in median post‐void residual urine volume were found after SRS in the three groups, while de novo stress urinary incontinence (SUI) developed in 10%, 44% and 60% of the patients in the unilateral J‐cut division, partial and subtotal removal groups, respectively (p = 0.007).
Conclusions
The unilateral J‐cut division technique was as effective as the partial and subtotal vaginal removal techniques in relieving MRUO with a shorter duration of surgery time (p = 0.001) and lower risk of de novo SUI (p = 0.007). Comparative studies with a larger number of patients are needed.
... Revision surgeries were classified into two groups: full removal or completion removal of their mid-urethral transobturator tape. 12 The length of tape removed was reported, as well as the presence of an orthopaedic surgeon with expertise in pelvic surgery. ...
... Further investigations (urethrocystoscopy, video-urodynamic study, ultrasonography, pelvic MRI and CT scan) were performed according to the main complaint/ symptoms and based on the diagnostic pathway previously published. 12 The choice of the type of surgery and extent of tape removal was made via a joint shared decision process between the patient and the surgeon. All cases were discussed in a multidisciplinary meeting (including urologists who specialised in mesh/tape complications, urogynaecologists, nurse specialists, psychologists, radiologists, physiotherapists, pain specialists and orthopaedic surgeons). ...
... Twenty-one per cent (n = 14) had previously undergone at least one tape removal and attended for complete removal for persistent pain and/or bothersome LUTS. The median interval between tape insertion and removal was eight years [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] (Table 1) Among the 18 patients with pre-operative voiding dysfunction, 13 answered the questionnaire, and 85% (n = 11) reported an improvement (≤2 on question 5 UDI-6). ...
Objective
The objective of this study is to describe a standardised technique of full TOT removal with groin dissection and to report clinical improvement, satisfaction, safety and long‐term functional, quality of life (QoL) and sexual QoL outcomes.
Materials and methods
A retrospective review enrolling all women who had full TOT removal, in a tertiary referral centre from May 2017 to November 2020. Functional outcomes, satisfaction and QoL were assessed using a bespoke composite questionnaire (UDI‐6, EQ‐5D‐5L and ICIQ‐S) with additional questions on sexual QoL. Secondary outcomes were post‐operative recurrent stress urinary incontinence (SUI) and complication rate according to the Clavien‐Dindo classification.
Results
Full TOT removal using a vaginal approach and bilateral groin/para‐labial incisions was performed in 67 patients. Chronic pelvic pain was the main indication for mesh removal (51% of cases, n = 34). QoL questionnaires were answered by 43 patients. The satisfaction rate was high 86% (n = 37), and 81% (n = 35) of the patients considered the surgery successful. Seventy per cent (n = 30) of patients returned to having a sexual life after surgery. Recurrent SUI was reported in 32% (n = 14) of cases. The complication rate was 10% (7/67), all of them Clavien–Dindo ≤2.
Conclusion
Despite a high rate of postoperative bothersome SUI, full TOT removal with bilateral groin dissection improves pain and QoL. It is associated with a high overall satisfaction rate and an acceptable rate of complications.
... These complications, ranging from immediate post-operative issues to problems arising several years post-insertion, can be severe [4]. Recognizing the gravity of the situation, the US Food and Drug Administration (FDA) released advisories in 2008 and 2011. ...
Introduction:
Pelvic organ prolapse (POP) is a prevalent condition among parous women, often warranting surgical intervention. This case accentuates the complications associated with mesh in POP surgeries, iterating the imperative need for an evidence-based approach towards its utilization and exhaustive patient counselling.
Case Presentation:
A 60-year-old female, post mesh-augmented POP repair, embarked on a 13-year journey characterized by persistent pelvic pain and multiple interventions. Despite undergoing several surgeries across different countries, involving mesh and stone removals, her symptoms, notably pelvic pain and dyspareunia, persisted. Clinical examinations revealed mesh erosion into the perivesical tissue, bladder, and associated stones, which were addressed through multiple interventions, albeit with transient success.
Discussion:
The complex journey of this patient exemplifies the intricate challenges mesh poses in POP surgeries. While mesh application offers a minimally invasive approach and has proven successful in numerous cases, it simultaneously opens a Pandora’s box of potential severe complications, necessitating thorough patient counselling and post-surgery management.
Conclusion:
The case delineates the challenging path that clinicians and patients tread when navigating through mesh-associated complications post-POP repair. Though mesh has been heralded as a revolutionary approach in POP surgeries, its potential drawbacks necessitate judicious application, ensuring clinicians are well-versed with its associated risks and are adept in managing ensuing complications.
... The pool of literature focusing on clinical aspects of surgical mesh complications continues to grow [5][6][7][8] . Writing about best practice in diagnosis and treatment, Bueno Garcia Reyes and Hashim describe the symptoms of patients with mesh complications saying that they can be "catastrophic" with a huge impact on health and quality of life 9 . There is now some international consensus on the management of mesh complications 10 . ...
This study follows up six women from a 2018 study examining the experience of women living with pelvic surgical mesh complications. Qualitative research relating to women's experience of treatment for mesh complications is limited. Participants had subsequently undergone surgical and non-surgical interventions for their complications. The aim of the current study was to understand the lived experience of these interventions and establish the impact of these interventions on participants' quality of life and wellbeing. Hermeneutic phenomenology was used with thematic analysis linking findings back to Van Manen's four lifeworld existentials used in the 2018 study-lived space, lived body, lived time and lived other. Participants completed a repeat International Consultation on Incontinence Modular Questionnaire Lower Urinary Tract quality of life (ICIQ-LUTSqol) questionnaire and following this were interviewed via Zoom using a semi-structured approach. During the interview participants self-rated their movement across recovery trajectories. Findings were compared between the 2018 study and the 2022 follow-up. Comparison of the women's 2018 and 2022 overall ICIQ-LUTSqol scores approached but did not reach statistical significance. However, most participants described some areas of improvement and improved quality of life after surgical and/or non-surgical intervention for mesh complications. These interventions, along with interactions with key health stakeholders, continue to have significant impacts, both positive and negative, on women's lived space, body, time, relationships and recoveries. Keywords surgical mesh, restorative, mesh complications For referencing Tuffnell JL. The experience of six women living with pelvic surgical mesh complications-interventions and adaptions: a phenomenological inquiry.
Background
To compare the effectiveness and safety of laparoscopic colposuspension using sutures (LCS) versus mesh and staples (LCM) in the treatment of female stress urinary incontinence.
Methods
This randomized study was conducted over a total of 80 women with genuine stress urinary incontinence between January 2020 and April 2022. Women were randomly assigned to the LCS group (n = 40) or the LCM group (n = 40). They underwent objective evaluations, including a standardized stress test, a 24-hour pad test, and a frequency-volume chart. Subjective assessments were made using a quality-of-life questionnaire.
Results
The LCS group exhibited superior outcomes in PAD test improvement (from 147 [31–304] to 3 [0–300] at 1 year, p < 0.001), stress test scores (from 82 [11–153] to 1 [0–124] at 1 year, p < 0.001), and mean micturated volume (increase from 294 ± 65 to 321 ± 57 at 1 year, p = 0.037) compared to the LCM group. Urodynamic findings revealed a higher Maximum Urethral Closure Pressure in the LCS group (33.1 ± 6.9) versus the LCM group (28.3 ± 6.4, p = 0.002). Quality of life improvements were significantly better in the LCS group across various domains. However, the LCM group benefitted from shorter surgery duration, hospital stays, and bladder drainage duration.
Conclusion
LCS demonstrates significant advantages over LCM in treating female stress urinary incontinence, particularly in cure rates and quality of life improvements. Despite the operational benefits of LCM in terms of reduced surgery and recovery times, LCS offers superior therapeutic outcomes.
Background
Determination of the learning curve of new techniques is essential to improve safety and efficiency. Limited information is available regarding learning curves of different techniques in laparoscopic pelvic floor surgery.
Objective
The aim of this study was to compare the learning curve of two operative techniques, laparoscopic lateral suspension (LLS) and laparoscopic sacrocolpopexy (LSC).
Material and methods
We conducted a prospective study to assess the learning curve of LLS and LSC by implementing a structured urogynecologic surgical training program with the use of pelvic trainers for our urogynecology fellow. The fellow was an experienced urogynecologic surgeon, but was laparoscopic suturing and dissection naive at the beginning of the study. She was required to assist in 20 laparoscopic urogynecologic surgeries and undertake laparoscopic suturing and knot tying training with mesh positioning on a laparoscopic trainer for 4 h/week during the trial period. After the completion of this structured training program, the fellow performed LLS and LSC under the supervision of an experienced subspecialist as the primary surgeon. Linear regression analysis was used to compare the data of LLS and LSC learning curves. Subjective pre- and post-operative evaluation of pelvic organ prolapse (POP) and pelvic floor disorders was undertaken preoperatively and 12 months postoperatively using the PFDI-20-Quality of Life validated questionnaire. Follow-up was scheduled 12 months after the surgery and performed by a skilled urogynecologist. Objective cure was defined as Pelvic Organ Prolapse-Qualification (POP-Q) stage <II in any compartment.
Results
The mean operative times of laparoscopic sacrocolpopexy and lateral suspension were 168.26 and 160.33 min, respectively. According to linear regression analysis after 43 procedures, the learning curve for laparoscopic lateral suspension was shorter than for laparoscopic sacrocolpopexy (OPTime 134.69 min). In both groups, there was a significant reduction in bothersome POP symptoms ( p ≤ 0.005). Bladder injuries in two cases and lumbar pain in one case were recorded during the study. Overall objective success at 12 months was 90.7% for LSC and 89.1% for LLS.
Conclusion
Laparoscopic lateral suspension could be an alternative to laparoscopic sacrocolpopexy in the treatment of POP with its good objective and subjective outcomes. Lateral suspension has a shorter learning curve, and it is technically less demanding than LSC. Procedure-dedicated training can accelerate the move from a novice to a master laparoscopic surgeon.
