Casey G Kowalik1, Joshua A Cohn2, Andrea Kakos3, Patrick Lang3, W Stuart Reynolds2, Melissa R Kaufman2, Mickey M Karram3, Roger R Dmochowski2. 1. Department of Urologic Surgery, Vanderbilt University Medical Center, A1302 Medical Center North, Nashville, TN, 37232-2765, USA. casey.kowalik@vanderbilt.edu. 2. Department of Urologic Surgery, Vanderbilt University Medical Center, A1302 Medical Center North, Nashville, TN, 37232-2765, USA. 3. Division of Female Pelvic Medicine and Reconstructive Surgery, The Christ Hospital Department of Obstetrics and Gynecology, Cincinnati, OH, USA.
Abstract
INTRODUCTION AND HYPOTHESIS: Urethral injury resulting from transvaginal mesh slings is a rare complication with an estimated incidence of <1%. Our objective was to review the surgical management and functional outcomes of women presenting with urethral mesh perforation following midurethral sling (MUS) placement. METHODS: This was a retrospective multicenter review of women who from January 2011 to March 2016 at two institutions underwent mesh sling excision for urethral perforation with Female Pelvic Medicine and Reconstructive Surgery fellowship-trained surgeons. Data comprising preoperative symptoms, operative details, and postoperative outcomes were collected by telephone (n 13) or based on their last follow-up appointment. RESULTS OBTAINED: Nineteen women underwent transvaginal sling excision for urethral mesh perforation. Eight (42%) patients had undergone previous sling revision surgery. Sixty percent of women had resolution of their pelvic pain postoperatively. At follow-up, 92% reported urinary incontinence (UI), and three had undergone five additional procedures for vaginal prolapse mesh exposure (n 1), incontinence (onabotulinum toxin injection n 1, rectus fascia autologous sling n 1), prolapse (colpopexy n 1), and pain (trigger-point injection n 1). Patient global impression of improvement data was available for 13 patients, of whom seven (54%) rated their postoperative condition as Very much better or Much better. CONCLUSIONS: The management of urethral mesh perforation is complex. Most women reported resolution of their pelvic pain and a high rate of satisfaction with their postoperative condition despite high rates of incontinence.
INTRODUCTION AND HYPOTHESIS: Urethral injury resulting from transvaginal mesh slings is a rare complication with an estimated incidence of <1%. Our objective was to review the surgical management and functional outcomes of women presenting with urethral mesh perforation following midurethral sling (MUS) placement. METHODS: This was a retrospective multicenter review of women who from January 2011 to March 2016 at two institutions underwent mesh sling excision for urethral perforation with Female Pelvic Medicine and Reconstructive Surgery fellowship-trained surgeons. Data comprising preoperative symptoms, operative details, and postoperative outcomes were collected by telephone (n 13) or based on their last follow-up appointment. RESULTS OBTAINED: Nineteen women underwent transvaginal sling excision for urethral mesh perforation. Eight (42%) patients had undergone previous sling revision surgery. Sixty percent of women had resolution of their pelvic pain postoperatively. At follow-up, 92% reported urinary incontinence (UI), and three had undergone five additional procedures for vaginal prolapse mesh exposure (n 1), incontinence (onabotulinum toxin injection n 1, rectus fascia autologous sling n 1), prolapse (colpopexy n 1), and pain (trigger-point injection n 1). Patient global impression of improvement data was available for 13 patients, of whom seven (54%) rated their postoperative condition as Very much better or Much better. CONCLUSIONS: The management of urethral mesh perforation is complex. Most women reported resolution of their pelvic pain and a high rate of satisfaction with their postoperative condition despite high rates of incontinence.
Authors: Bernard T Haylen; Robert M Freeman; Steven E Swift; Michel Cosson; G Willy Davila; Jan Deprest; Peter L Dwyer; Brigitte Fatton; Ervin Kocjancic; Joseph Lee; Chris Maher; Eckhard Petri; Diaa E Rizk; Peter K Sand; Gabriel N Schaer; Ralph Webb Journal: Neurourol Urodyn Date: 2011-01 Impact factor: 2.696
Authors: Jennifer M Wu; Catherine A Matthews; Mitchell M Conover; Virginia Pate; Michele Jonsson Funk Journal: Obstet Gynecol Date: 2014-06 Impact factor: 7.661
Authors: Goran Rac; Austin Younger; James Q Clemens; Kathleen Kobashi; Aqsa Khan; Victor Nitti; Ilana Jacobs; Gary E Lemack; Elizabeth T Brown; Roger Dmochowski; Lara MacLachlan; Arthur Mourtzinos; David Ginsberg; Michelle Koski; Ross Rames; Eric S Rovner Journal: Neurourol Urodyn Date: 2016-07-26 Impact factor: 2.696