Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Current Urology Reports
Published in: Current Urology Reports 9/2016

01-09-2016 | Lower Urinary Tract Symptoms & Voiding Dysfunction (H Goldman and G Badlani, Section Editors)

Mesh Perforation into a Viscus in the Setting of Pelvic Floor Surgery—Presentation and Management

Authors: Seth A. Cohen, Howard B. Goldman

Published in: Current Urology Reports | Issue 9/2016

Login to get access

Abstract

Perforation of a viscus with a mesh product either during or subsequent to pelvic floor reconstruction can be associated with devastating outcomes. If surgeons are going to place mesh, they also need to be familiar with symptoms concerning for perforation. The index of suspicion should always be present, as these patients can present years after initial mesh placement. The best opportunity for intervention in these serious complications is the first intervention. As bits of mesh are chipped away during attempted interventions, residual mesh fragments become disjointed, frayed, and scarred further, making their removal even more challenging, in addition to traumatizing likely already weakened tissues. This review presents strategies for patient evaluation in the setting of possible mesh perforation, in addition to treatment strategies for urethral, bladder, ureteral, and colonic/rectal injury. Ultimately, the decision as to how much mesh is removed should be based on each patient’s unique presentation.
Literature
1.
Haylen BT, Freeman RM, Swift SE, Cosson M, Davila GW, Deprest J, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint terminology and classification of the complications related directly to the insertion of prostheses (meshes, implants, tapes) and grafts in female pelvic floor surgery. Neurourol Urodyn. 2011;30(1):2–12.CrossRefPubMed
2.••
Blaivas JG, Purohit RS, Benedon MS, Mekel G, Stern M, Billah M, et al. Safety considerations for synthetic sling surgery. Nat Rev Urol. 2015;12(9):481–509. The authors provide a comprehensive discussion of the literature available regarding complications and outcomes of intervention, in the setting of MUS placement.CrossRefPubMed
3.
Osborn DJ, Dmochowski RR, Harris CJ, Danford JJ, Kaufman MR, Mock S, et al. Analysis of patient and technical factors associated with midurethral sling mesh exposure and perforation. Int J Urol. 2014;21(11):1167–70.CrossRefPubMedPubMedCentral
4.
Daneshgari F, Kong W, Swartz M. Complications of mid urethral slings: important outcomes for future clinical trials. J Urol. 2008;180(5):1890–7.CrossRefPubMed
5.
Welk B, Al-Hothi H, Winick-Ng J. Removal or revision of vaginal mesh used for the treatment of stress urinary incontinence. JAMA Surg. 2015;150(12):1167–75.CrossRefPubMed
6.
Deng T, Liao B, Luo D, Shen H, Wang K. Risk factors for mesh erosion after female pelvic floor reconstructive surgery: a systematic review and meta-analysis. BJU Int. 2016;117(2):323–43.CrossRefPubMed
7.
Richter HE, Albo ME, Zyczynski HM, Kenton K, Norton PA, Sirls LT, et al. Retropubic versus transobturator midurethral slings for stress incontinence. N Engl J Med. 2010;362(22):2066–76.CrossRefPubMedPubMedCentral
8.
Blaivas JG, Sandhu J. Urethral reconstruction after erosion of slings in women. Curr Opin Urol. 2004;14(6):335–8.CrossRefPubMed
9.
Lang P, Oliphant S, Mizell J, Austin B, Barr S. Rectal perforation at the time of vaginal mesh placement and subsequent abdominal mesh removal. Int Urogynecol J. 2015;26(10):1545–6.CrossRefPubMed
10.•
Staack A, Vitale J, Ragavendra N, Rodriguez LV. Translabial ultrasonography for evaluation of synthetic mesh in the vagina. Urology. 2014;83(1):68–74. This manuscript provides a useful description of the clinical utilities of translabial ultrasound to identify mesh material, including informing surgical planning and counseling.CrossRefPubMed
11.
Manonai J, Rostaminia G, Denson L, Shobeiri SA. Clinical and ultrasonographic study of patients presenting with transvaginal mesh complications. Neurourol Urodyn. 2015.
12.
Almassi N, Goldman HB. Intraoperative ultrasound-guided removal of retained mini sling anchor causing vaginal pain: a case report. Female Pelvic Med Reconstr Surg. 2016;22(1):e17–9.CrossRefPubMed
13.
Kuuva N, Nilsson CG. A nationwide analysis of complications associated with the tension-free vaginal tape (TVT) procedure. Acta Obstet Gynecol Scand. 2002;81(1):72–7.CrossRefPubMed
14.
Hammad FT, Kennedy-Smith A, Robinson RG. Erosions and urinary retention following polypropylene synthetic sling: Australasian survey. Eur Urol. 2005;47(5):641–6. discussion 6–7.CrossRefPubMed
15.
Abdel-Fattah M, Ramsay I, Pringle S. Lower urinary tract injuries after transobturator tape insertion by different routes: a large retrospective study. BJOG. 2006;113(12):1377–81.CrossRefPubMed
16.
Ward KL, Hilton P. Uk, Ireland TVTTG. Tension-free vaginal tape versus colposuspension for primary urodynamic stress incontinence: 5-year follow up. BJOG. 2008;115(2):226–33.CrossRefPubMed
17.
Shah K, Nikolavsky D, Gilsdorf D, Flynn BJ. Surgical management of lower urinary mesh perforation after mid-urethral polypropylene mesh sling: mesh excision, urinary tract reconstruction and concomitant pubovaginal sling with autologous rectus fascia. Int Urogynecol J. 2013;24(12):2111–7.CrossRefPubMed
18.
Colhoun A, Rapp DE. Long-term outcomes after repair of transurethral perforation of midurethral sling. Female Pelvic Med Reconstr Surg. 2016;22(4):272–5.
19.
Baracat F, Mitre AI, Kanashiro H, Montellato NI. Endoscopic treatment of vesical and urethral perforations after tension-free vaginal tape (TVT) procedure for female stress urinary incontinence. Clinics (Sao Paulo). 2005;60(5):397–400.CrossRef
20.
Ogle CA, Linder BJ, Elliott DS. Holmium laser excision for urinary mesh erosion: a minimally invasive treatment with favorable long-term results. Int Urogynecol J. 2015;26(11):1645–8.CrossRefPubMed
21.
Macedo FI, O’Connor J, Mittal VK, Hurley P. Robotic removal of eroded vaginal mesh into the bladder. Int J Urol. 2013;20(11):1144–6.CrossRefPubMed
22.
Clifton MM, Goldman HB. Erosion of prolene sutures into the bladder after abdominal sacrocolpopexy. Int Urogynecol J. 2015;26(12):1875–6.CrossRefPubMed
23.
Ingber MS, Stein RJ, Rackley RR, Firoozi F, Irwin BH, Kaouk JH, et al. Single-port transvesical excision of foreign body in the bladder. Urology. 2009;74(6):1347–50.CrossRefPubMed
24.
Ucar MG, Avci ME, Sanlikan F. A novel insight into the treatment of an intravesical eroded mesh: endoscopic-assisted cystoscopic approach. Int Urogynecol J. 2016;27(3):499–501.CrossRefPubMed
25.
Bieniek JM, Holste TL, Platte RO, Minassian VA. Cystoscopic removal of intravesical synthetic mesh extrusion with the aid of Endoloop sutures and endoscopic scissors. Int Urogynecol J. 2012;23(8):1137–9.CrossRefPubMed
26.
Pikaart DP, Miklos JR, Moore RD. Laparoscopic removal of pubovaginal polypropylene tension-free tape slings. JSLS: J Soc Laparoendosc Surg. 2006;10(2):220–5.
27.
Firoozi F, Ingber MS, Goldman HB. Pure transvaginal removal of eroded mesh and retained foreign body in the bladder. Int Urogynecol J. 2010;21(6):757–60.CrossRefPubMed
28.
Firoozi F, Ingber MS, Moore CK, Vasavada SP, Rackley RR, Goldman HB. Purely transvaginal/perineal management of complications from commercial prolapse kits using a new prostheses/grafts complication classification system. J Urol. 2012;187(5):1674–9.CrossRefPubMed
29.
Yamada BS, Govier FE, Stefanovic KB, Kobashi KC. Vesicovaginal fistula and mesh erosion after Perigee (transobturator polypropylene mesh anterior repair). Urology. 2006;68(5):1121. e5-7.CrossRefPubMed
30.
Araco F, Gravante G, Piccione E. Bladder erosion after 2 years from cystocele repair with type I polypropylene mesh. Int Urogynecol J Pelvic Floor Dysfunct. 2009;20(6):731–3.CrossRefPubMed
31.
Choi JM, Nguyen V, Khavari R, Reeves K, Snyder M, Fletcher SG. Complex rectovaginal fistulas after pelvic organ prolapse repair with synthetic mesh: a multidisciplinary approach to evaluation and management. Female Pelvic Med Reconstr Surg. 2012;18(6):366–71.CrossRefPubMed
32.
Ouaïssi M, Cresti S, Giger U, Sielezneff I, Pirrò N, Berthet B, et al. Management of recto-vaginal fistulas after prosthetic reinforcement treatment for pelvic organ prolapse. World J Gastroenterol. 2010;16(24):3011–5.CrossRefPubMedPubMedCentral
33.
Nygaard I, Brubaker L, Zyczynski HM, Cundiff G, Richter H, Gantz M, et al. Long-term outcomes following abdominal sacrocolpopexy for pelvic organ prolapse. JAMA. 2013;309(19):2016–24.CrossRefPubMedPubMedCentral
34.
Hirai CA, Bohrer JC, Ruel M, Minaglia SM. Rectal mesh erosion after robotic sacrocolpopexy. Female Pelvic Med Reconstr Surg. 2013;19(5):298–300.CrossRefPubMed
35.
Hurtado EA, Bailey HR, Reeves KO. Rectal erosion of synthetic mesh used in posterior colporrhaphy requiring surgical removal. Int Urogynecol J Pelvic Floor Dysfunct. 2007;18(12):1499–501.CrossRefPubMed
36.
Mickelson L, Miklos JR, Moore RD. Laparoscopic repair of enterocervical fistula after mesh erosion into the sigmoid colon and cervix after robotic supracervical hysterectomy and sacrocervicopexy. Female Pelvic Med Reconstr Surg. 2016;22(1):e3–5.CrossRefPubMed
37.
Paine M, Harnsberger JR, Whiteside JL. Transrectal mesh erosion remote from sacrocolpopexy: management and comment. Am J Obstet Gynecol. 2010;203(2):e11–3.CrossRefPubMed
38.•
Wolff GF, Winters JC, Krlin RM. Mesh excision: is total mesh excision necessary? Curr Urol Rep. 2016;17(4):34. This review provides helpful insight into the clinical question of whether total versus partial removal of mesh is necessary for the resolution of complications following transvaginal mesh placement. CrossRefPubMed
39.
Weber LeBrun E, Adam RA, Barber MD, Boyles SH, Iglesia CB, Lukacz ES, et al. Pelvic floor disorders registry: study design and outcome measures. Female Pelvic Med Reconstr Surg. 2016;22(2):70–6.CrossRefPubMed
Metadata
Title
Mesh Perforation into a Viscus in the Setting of Pelvic Floor Surgery—Presentation and Management
Authors
Seth A. Cohen
Howard B. Goldman
Publication date
01-09-2016
Publisher
Springer US
Published in
Current Urology Reports / Issue 9/2016
Print ISSN: 1527-2737
Electronic ISSN: 1534-6285
DOI
https://doi.org/10.1007/s11934-016-0621-3

Other articles of this Issue 9/2016

Current Urology Reports 9/2016 Go to the issue

Lower Urinary Tract Symptoms & Voiding Dysfunction (H Goldman and G Badlani, Section Editors)

Vaginal Mesh Exposure Presentation, Evaluation, and Management

UROSURGERY (J COLLINS, SECTION EDITOR)

High-Risk Non-Muscle-Invasive Bladder Cancer—Therapy Options During Intravesical BCG Shortage

Case Report

Ct2 Bladder Cancer

New Imaging Techniques (A Rastinehad and S Rais-Bahrami, Section Editors)

Preoperative Imaging for Clinical Staging Prior to Radical Cystectomy

Men’s Health (A Dabaja, Section Editor)

Peyronie’s Disease: Intralesional Therapy and Surgical Intervention

Benign Prostatic Hyperplasia (K McVary, Section Editor)

Urolift: a New Face of Minimally Invasive Surgical Technique for Benign Prostatic Hyperplasia?