Management of Sacrocolpopexy Mesh Complications-A Narrative Review and Clinical Experience from a Large-Volume Center.

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Tác giả: Howard B Goldman, Chen Shenhar

Ngôn ngữ: eng

Ký hiệu phân loại: 617.96041 Operative surgery and special fields of surgery

Thông tin xuất bản: England : International urogynecology journal , 2025

Mô tả vật lý:

Bộ sưu tập: NCBI

ID: 643144

 INTRODUCTION AND HYPOTHESIS: Despite the reputation of sacrocolpopexy as a highly durable reconstructive surgery for pelvic organ prolapse, mesh-related complications remain a significant deterrent for patients. This review discusses the incidence, presentation, diagnosis, management and prevention of sacrocolpopexy mesh complications. METHODS: We reviewed the literature on sacrocolpopexy focusing on long-term mesh complications and their management. As the literature is not specifically robust, we also give our recommendations based on experience from a large-volume center. Intraoperative videos and images are provided to illustrate findings and management techniques. RESULTS: Sacrocolpopexy mesh complications include vaginal mesh exposure
  bladder or bowel erosions
  inflammatory and infectious conditions including spondylodiscitis
  and mesh-related pain. Presentation ranges from overt symptoms such as mesh palpated in the vagina to insidious-like spondylodiscitis manifesting as back pain and malaise. Diagnosis relies on methodical history taking, review of operative reports, and a physical examination, with office-based endoscopy studies and imaging as indicated. Various management options have been described in the literature. We recommend an expectant approach for asymptomatic patients
  For symptomatic vaginal exposure, we encourage removal of entire mesh arm(s) via an abdominal approach
  however, many prefer to utilize a transvaginal or partial excisional approach first. Spondylodiscitis is managed with long-term antibiotics and often requires mesh removal. Prevention strategies include using a lightweight polypropylene mesh attached to well- vascularized vaginal walls, avoiding direct placement on any sutured vaginotomy or cystotomy. Delayed absorbable monofilament suture is non-inferior to permanent suture. CONCLUSIONS: Sacrocolpopexy mesh complications can be challenging to diagnose and manage. Symptomatic cases often require a proactive approach
  listening to patients when they describe persistent symptoms with postoperative onset
  a low threshold for further evaluation
  and upfront discussion of management options.
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