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pelvic reconstructive surgery

Indications: - pelvic organ prolapse* * not recommended Complications: - vesicovaginal fistula results in urinary incontinence, vaginal bleeding with coitus, dyspareunia, vaginal discharge - recurrence of pelvic organ prolapse - mesh erosion (10%) - may cause bleeding, discomfort or discharge or may be asymptomatic - mesh may erode into the bladder or bowel (1%) causing dysuria, urinary urgency, urinary frequency, hematuria, dyschezia, pelvic pain - obstructive uropathy - bowel onstruction - mesh contracture may cause pain & dysparunia - vaginal mesh exposure is the most common complication - characterized by vaginal discharge, dyspareunia, vulvar irritation - exposed vaginal mesh may be seen on speculum exam or palpated on bimanual pelvic exam as bristly plastic* * topical vaginal estrogen may suffice to treat symptoms of exposed vaginal mesh without surgical removal [1] Management: - self-removal of indwelling urinary catheter with similar postoperative outcome & greater satisfaction vs-office removal [5]

Related

vaginal mesh

Specific

sacrocolpopexy urethral sling procedure

General

pelvic surgery

References

  1. Geriatric Review Syllabus, 9th edition (GRS9) Medinal-Walpole A, Pacala JT, Porter JF (eds) American Geriatrics Society, 2016 - Geriatric Review Syllabus, 10th edition (GRS10) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2019
  2. Abbott S, Unger CA, Evans JM et al Evaluation and management of complications from synthetic mesh after pelvic reconstructive surgery: a multicenter study. Am J Obstet Gynecol. 2014 Feb;210(2):163.e1-8 PMID: 24126300
  3. Crosby EC, Abernethy M, Berger MB et al Symptom resolution after operative management of complications from transvaginal mesh. Obstet Gynecol. 2014 Jan;123(1):134-9. PMID: 24463673 Free PMC Article
  4. Ellington DR, Richter HE. The role of vaginal mesh procedures in pelvic organ prolapse surgery in view of complication risk. Obstet Gynecol Int. 2013;2013:356960. Review. PMID: 24069035 Free PMC Article
  5. Shatkin-Margolis A et al. Self-removal of a urinary catheter after urogynecologic surgery: A randomized controlled trial. Obstet Gynecol 2019 Nov; 134:1027 PMID: 31599827 https://insights.ovid.com/crossref?an=00006250-201911000-00017