Road to recovery after transvaginal surgery for urethral mesh perforation: evaluation of outcomes and subsequent procedures.

Kowalik CG, Cohn JA, Kakos A, Lang P, Reynolds WS, Kaufman MR, Karram MM, Dmochowski RR
Int Urogynecol J. 2018 29 (6): 887-892

PMID: 29379998 · DOI:10.1007/s00192-018-3563-0

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.

MeSH Terms (13)

Adult Aged Female Humans Male Middle Aged Retrospective Studies Suburethral Slings Surgical Mesh Treatment Outcome Urethra Urinary Incontinence, Stress Urinary Incontinence, Urge

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