TY - JOUR
T1 - Road to recovery after transvaginal surgery for urethral mesh perforation
T2 - evaluation of outcomes and subsequent procedures
AU - Kowalik, Casey G.
AU - Cohn, Joshua A.
AU - Kakos, Andrea
AU - Lang, Patrick
AU - Reynolds, W. Stuart
AU - Kaufman, Melissa R.
AU - Karram, Mickey M.
AU - Dmochowski, Roger R.
N1 - Publisher Copyright:
© 2018, The International Urogynecological Association.
PY - 2018/6/1
Y1 - 2018/6/1
N2 - 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.
AB - 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.
KW - Midurethral sling
KW - Postoperative complications
KW - Surgical mesh
KW - Urethral reconstruction
UR - http://www.scopus.com/inward/record.url?scp=85041116352&partnerID=8YFLogxK
U2 - 10.1007/s00192-018-3563-0
DO - 10.1007/s00192-018-3563-0
M3 - Article
C2 - 29379998
AN - SCOPUS:85041116352
SN - 0937-3462
VL - 29
SP - 887
EP - 892
JO - International Urogynecology Journal
JF - International Urogynecology Journal
IS - 6
ER -