Adverse events following transvaginal mesh surgery for stress urinary incontinence and pelvic organ prolapse in women

2017 ◽  
Author(s):  
Sophie Robertson
Keyword(s):  
Urinary Incontinence ◽  
Pelvic Organ Prolapse ◽  
Stress Urinary Incontinence ◽  
Adverse Events ◽  
Pelvic Organ ◽  
Transvaginal Mesh ◽  
Mesh Surgery

scholarly journals Clinical Outcomes and Urodynamic Effects of Tailored Transvaginal Mesh Surgery for Pelvic Organ Prolapse

2015 ◽  
Vol 2015 ◽  
pp. 1-9 ◽  
Author(s):  
Ting-Chen Chang ◽  
Sheng-Mou Hsiao ◽  
Chi-Hau Chen ◽  
Wen-Yih Wu ◽  
Ho-Hsiung Lin
Keyword(s):  
Quality Of Life ◽  
Urinary Incontinence ◽  
Pelvic Organ Prolapse ◽  
Stress Urinary Incontinence ◽  
Clinical Outcomes ◽  
Positive Impact ◽  
Pelvic Organ ◽  
Transvaginal Mesh ◽  
Mesh Surgery

Objective. To evaluate the clinical outcomes and urodynamic effects of tailored anterior transvaginal mesh surgery (ATVM) and tailored posterior transvaginal mesh surgery (PTVM).Methods. We developed ATVM for the simultaneous correction of cystocele and stress urinary incontinence and PTVM for the simultaneous correction of enterocoele, uterine prolapse, vaginal stump prolapse, and rectocele.Results. A total of 104 women enrolled. The median postsurgical follow-up was 25.5 months. The anatomic cure rate was 98.1% (102/104). Fifty-eight patients underwent urodynamic studies before and after surgeries. The pad weight decreased from 29.3 ± 43.1 to 6.4 ± 20.9 g at 3 months. Among the 20 patients with ATVM, 13 patients had objective stress urinary incontinence (SUI) at baseline while 8 patients came to have no demonstrated SUI (NDSUI), and 2 improved after surgery. Among the 38 patients who underwent ATVM and PTVM, 24 had objective SUI at baseline while 18 came to have NDSUI, and 2 improved after surgery. Mesh extrusion (n= 4), vaginal hematoma (n= 3), and voiding difficulty (n= 2) were noted postoperatively. Quality of life was substantially improved.Conclusions. Our findings document the advantages of these two novel pelvic reconstructive surgeries for pelvic organ prolapse, which had a positive impact on quality of life. ATVM surgery additionally provided an anti-incontinence effect. This clinical trial is registered at ClinicalTrials.gov (NCT02178735).

scholarly journals Occurrence of Pre- and Postoperative Stress Urinary Incontinence in 105 Patients Who Underwent Tension-Free Vaginal Mesh Surgery for Pelvic Organ Prolapse: A Retrospective Study

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Haruhiko Kanasaki ◽  
Aki Oride ◽  
Tomomi Mitsuo ◽  
Kohji Miyazaki
Keyword(s):  
Urinary Incontinence ◽  
Pelvic Organ Prolapse ◽  
Stress Urinary Incontinence ◽  
De Novo ◽  
Urine Volume ◽  
Pelvic Organ ◽  
Postoperative Changes ◽  
Mesh Surgery ◽  
Postoperative Stress ◽  
Transvaginal Mesh Repair

Objective. To examine retrospectively the occurrence of stress urinary incontinence (SUI) in patients who underwent transvaginal mesh repair (TVM) for pelvic organ prolapse (POP). Methods. The presence of preoperative SUI and postoperative changes in SUI was retrospectively analyzed for 105 patients who underwent TVM for POP between September 2009 and September 2012. Results. Preoperative SUI was observed in almost half of the patients (n=50) who underwent TVM surgery. No significant differences were seen in patient age, pelvic organ prolapse quantification (POP-Q) stage, or primary POP complaint between those with and without preoperative SUI. Of the 50 patients with preoperative SUI, SUI was resolved in 14 (28%) following TVM surgery. Of the 55 patients without preoperative SUI, de novo postoperative SUI appeared in 26 (47.3%), of whom approximately half experienced resolution or improvement of SUI within 6 months postoperatively. There was no relationship between preoperative residual urine volume and occurrence of postoperative SUI. Conclusion. TVM surgery is a useful surgical method that can replace traditional methods for treating POP, but sufficient informed consent with regards to the onset of postoperative SUI is required.

scholarly journals The mesh controversy

F1000Research ◽  
2016 ◽  
Vol 5 ◽  
pp. 2423 ◽  
Author(s):  
Joshua A. Cohn ◽  
Elizabeth Timbrook Brown ◽  
Casey G. Kowalik ◽  
Melissa R. Kaufman ◽  
Roger R. Dmochowski ◽  
...  
Keyword(s):  
Urinary Incontinence ◽  
Pelvic Organ Prolapse ◽  
Stress Urinary Incontinence ◽  
Pelvic Organ ◽  
Transvaginal Mesh ◽  
Class Iii ◽  
Regulatory Oversight ◽  
Mesh Placement ◽  
Recent Developments ◽  
Uncertain Future

Pelvic organ prolapse and stress urinary incontinence are common conditions for which approximately 11% of women will undergo surgical intervention in their lifetime. The use of vaginal mesh for pelvic organ prolapse and stress urinary incontinence rose rapidly in the early 2000s as over 100 mesh products were introduced into the clinical armamentarium with little regulatory oversight for their use. US Food and Drug Administration Public Health Notifications in 2008 and 2011, as well as reclassification of transvaginal mesh for prolapse to class III in early 2016, were a response to debilitating complications associated with transvaginal mesh placement in many women. The midurethral sling has not been subject to the same reclassification and continues to be endorsed as the “gold standard” for surgical management of stress urinary incontinence by subspecialty societies. However, litigators have not differentiated between mesh for prolapse and mesh for incontinence. As such, all mesh, including that placed for stress urinary incontinence, faces continued controversy amidst an uncertain future. In this article, we review the background of the mesh controversy, recent developments, and the anticipated role of mesh in surgery for prolapse and stress urinary incontinence going forward.

Synthetic Mesh Used in Gynecologic Reconstructive Surgery for Pelvic Floor Disorders

2017 ◽  
Vol 752 ◽  
pp. 59-63
Author(s):  
Elvira Brătilă ◽  
Petre Brătilă ◽  
Diana Comandașu ◽  
Monica Cîrstoiu ◽  
Roxana Bohîlțea ◽  
...  
Keyword(s):  
Urinary Incontinence ◽  
Pelvic Organ Prolapse ◽  
Stress Urinary Incontinence ◽  
Pelvic Floor ◽  
Pelvic Floor Disorders ◽  
Pelvic Organ ◽  
Synthetic Mesh ◽  
Effective Porosity ◽  
Apical Prolapse ◽  
Mesh Surgery

Pelvic floor disorders including stress urinary incontinence and pelvic organ prolapse represent a challenge for gynecologist or urogynecologist even nowadays. Conservative treatment for these conditions proves its effectiveness only in few cases selected from early forms of incontinence or prolapse the most cases being solved surgically. The introduction of the procedure imagined by Petros and Ulmsten, known as TVT (Trans Vaginal Tape) in which the medium urethra is supported by a synthetic tape produced in 1996 a revolution in the surgical treatment of stress urinary incontinence. Radical changes also appeared in pelvic organ prolapse surgery extrapolating the hernia repair procedure by using synthetic mesh. After nearly 20 years of experience the mesh surgery is today a common practice in urogynecology. Between 2011 and 2015 we operated in private practice a total number of 297 cases of which 187 cases of stress urinary incontinence and 110 cases of pelvic organ prolapse. From these 86 (78,1%) cases were represented by cystoceles, associated with early apical prolapse or rectoceles, 18 (16,3%) cases by apical prolapse (grade III-IV) and 6 (5,4%) cases by posterior compartment prolapse alone. We performed mesh surgery in 32 (29%) cases represented mainly by anterior compartment prolapse. In 6 (18,7%) cases we founded mesh extrusion which required partially resection. In two cases we performed large resection of anterior vaginal wall required grafting with acellular second generation graft. In all cases with mesh extrusion the biomechanical analysis revealed significant decrease in effective porosity of the mesh due to excessive tensioning or folding of the mesh. The use of mesh in stress urinary incontinence and pelvic organ prolapse represent a justified alternative in selected cases. The specific complications due to meshes are more frequent in prolapse surgery compared to stress urinary incontinence. In all cases altered effective porosity due to technical defects in surgery represents the leading cause.

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