Purely transvaginal/perineal management of complications from commercial prolapse kits using a new prostheses/grafts complication classification system

Farzeen Firoozi, Michael Ingber, Courtenay K. Moore, Sandip P. Vasavada, Raymond R. Rackley, Howard B. Goldman

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

Purpose: Commercial prolapse mesh kits are increasingly used in the management of pelvic organ prolapse. We present our experience with the transvaginal/perineal management of synthetic mesh related complications from prolapse kits. In addition, we used the new ICS/IUGA (International Continence Society/International Urogynecological Association) prostheses/grafts complication classification system to report on our contemporary series. Materials and Methods: A retrospective chart review of all patients who underwent surgical removal of transvaginal mesh for mesh related complications after prolapse kit use from November 2006 to April 2010 at 1 institution was performed. We report our contemporary series of mesh complications using the new ICS/IUGA prostheses/grafts complication classification system. Postoperative pain, degree of improvement and presence of continued symptoms were reported by patients at last followup. Results: A total of 23 patients underwent transvaginal removal of mesh during the study period. Mean patient age was 61 years. Median period of latency to mesh related complication was 10 months (range 1 to 27). Indications for mesh removal included vaginal/pelvic pain (39%), dyspareunia (39%), vaginal mesh extrusion/exposure (26%), urinary incontinence (35%), recurrent pelvic organ prolapse (22%), bladder mesh perforation with recurrent urinary tract infection (22%), rectal mesh perforation (4%), ureteral perforation injury (4%), retained foreign body (surgical sponge) in the bladder (4%) and vesicovaginal fistula (9%), with most patients citing more than 1 reason. Conclusions: Although technically difficult in some cases, purely transvaginal mesh excision appears to be safe with resolution of almost all presenting symptoms. Although slightly cumbersome, the new ICS/IUGA prostheses/graft complication classification system can be used to report and more accurately characterize mesh complications.

Original languageEnglish (US)
Pages (from-to)1674-1679
Number of pages6
JournalJournal of Urology
Volume187
Issue number5
DOIs
StatePublished - May 1 2012
Externally publishedYes

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Prolapse
Prostheses and Implants
Transplants
Pelvic Organ Prolapse
Urinary Bladder
Surgical Sponges
Vesicovaginal Fistula
Dyspareunia
Pelvic Pain
Urinary Incontinence
Postoperative Pain
Foreign Bodies
Urinary Tract Infections
Wounds and Injuries

All Science Journal Classification (ASJC) codes

  • Urology

Cite this

Firoozi, Farzeen ; Ingber, Michael ; Moore, Courtenay K. ; Vasavada, Sandip P. ; Rackley, Raymond R. ; Goldman, Howard B. / Purely transvaginal/perineal management of complications from commercial prolapse kits using a new prostheses/grafts complication classification system. In: Journal of Urology. 2012 ; Vol. 187, No. 5. pp. 1674-1679.
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title = "Purely transvaginal/perineal management of complications from commercial prolapse kits using a new prostheses/grafts complication classification system",
abstract = "Purpose: Commercial prolapse mesh kits are increasingly used in the management of pelvic organ prolapse. We present our experience with the transvaginal/perineal management of synthetic mesh related complications from prolapse kits. In addition, we used the new ICS/IUGA (International Continence Society/International Urogynecological Association) prostheses/grafts complication classification system to report on our contemporary series. Materials and Methods: A retrospective chart review of all patients who underwent surgical removal of transvaginal mesh for mesh related complications after prolapse kit use from November 2006 to April 2010 at 1 institution was performed. We report our contemporary series of mesh complications using the new ICS/IUGA prostheses/grafts complication classification system. Postoperative pain, degree of improvement and presence of continued symptoms were reported by patients at last followup. Results: A total of 23 patients underwent transvaginal removal of mesh during the study period. Mean patient age was 61 years. Median period of latency to mesh related complication was 10 months (range 1 to 27). Indications for mesh removal included vaginal/pelvic pain (39{\%}), dyspareunia (39{\%}), vaginal mesh extrusion/exposure (26{\%}), urinary incontinence (35{\%}), recurrent pelvic organ prolapse (22{\%}), bladder mesh perforation with recurrent urinary tract infection (22{\%}), rectal mesh perforation (4{\%}), ureteral perforation injury (4{\%}), retained foreign body (surgical sponge) in the bladder (4{\%}) and vesicovaginal fistula (9{\%}), with most patients citing more than 1 reason. Conclusions: Although technically difficult in some cases, purely transvaginal mesh excision appears to be safe with resolution of almost all presenting symptoms. Although slightly cumbersome, the new ICS/IUGA prostheses/graft complication classification system can be used to report and more accurately characterize mesh complications.",
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Purely transvaginal/perineal management of complications from commercial prolapse kits using a new prostheses/grafts complication classification system. / Firoozi, Farzeen; Ingber, Michael; Moore, Courtenay K.; Vasavada, Sandip P.; Rackley, Raymond R.; Goldman, Howard B.

In: Journal of Urology, Vol. 187, No. 5, 01.05.2012, p. 1674-1679.

Research output: Contribution to journalArticle

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N2 - Purpose: Commercial prolapse mesh kits are increasingly used in the management of pelvic organ prolapse. We present our experience with the transvaginal/perineal management of synthetic mesh related complications from prolapse kits. In addition, we used the new ICS/IUGA (International Continence Society/International Urogynecological Association) prostheses/grafts complication classification system to report on our contemporary series. Materials and Methods: A retrospective chart review of all patients who underwent surgical removal of transvaginal mesh for mesh related complications after prolapse kit use from November 2006 to April 2010 at 1 institution was performed. We report our contemporary series of mesh complications using the new ICS/IUGA prostheses/grafts complication classification system. Postoperative pain, degree of improvement and presence of continued symptoms were reported by patients at last followup. Results: A total of 23 patients underwent transvaginal removal of mesh during the study period. Mean patient age was 61 years. Median period of latency to mesh related complication was 10 months (range 1 to 27). Indications for mesh removal included vaginal/pelvic pain (39%), dyspareunia (39%), vaginal mesh extrusion/exposure (26%), urinary incontinence (35%), recurrent pelvic organ prolapse (22%), bladder mesh perforation with recurrent urinary tract infection (22%), rectal mesh perforation (4%), ureteral perforation injury (4%), retained foreign body (surgical sponge) in the bladder (4%) and vesicovaginal fistula (9%), with most patients citing more than 1 reason. Conclusions: Although technically difficult in some cases, purely transvaginal mesh excision appears to be safe with resolution of almost all presenting symptoms. Although slightly cumbersome, the new ICS/IUGA prostheses/graft complication classification system can be used to report and more accurately characterize mesh complications.

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