Management and outcomes of mesh complications in female pelvic floor surgery from a national salvage centre
BAUS ePoster online library. Jaffer A. 06/25/19; 259568; P7-4
Mr. Ata Jaffer
Mr. Ata Jaffer
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Abstract
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INTRODUCTION

Stress UI (SUI) has been treated with synthetic mesh through a variety of approaches for >20 years. There have recently been a number of high profile cases highlighting catastrophic complications which has a sparked a pause on all vaginally inserted mesh/tapes to treat SUI/pelvic organ prolapse. We present our experience of managing patients referred with mesh related complications requiring intervention at our national salvage centre.

Patients and materials
Review of prospectively maintained database for patients referred with complications related to mesh insertion between 2012-2018.

Results
In all, 59 patients were identified. Presenting complaints included pain/dyspareunia (n=17), voiding dysfunction (n=12), LUTS/incontinence (n=11), recurrent UTI's (n=7), visible vaginal erosion (n=7), bladder stone (n=2) and haematuria (n=3). Erosion had occurred in 43 cases (27 vaginal, 8 urethral and 7 bladder). Patients were discussed in the Pelvic Floor MDT and reported to HMRA. Majority had their initial incontinence procedure in other units. Salvage procedures performed included; Laparoscopic & cystoscopic assisted excision of eroded mesh +/- fistula repair (one required laparotomy), total excision of vaginal part of tape +/- Martius vaginal flap. Recurrent SUI after salvage surgery occurred in 23% of patients, with the majority treated successfully with autologous pubovaginal slings or Bulkamid.

CONCLUSION

Our centre follows NHS England Mesh group, British Association of Urological Surgeons (BAUS) and British Society of Urogynaecology (BSUG) recommendations. Such complications can result in disabling and catastrophic consequences and should be managed in specialist centres and streamline management plans.
INTRODUCTION

Stress UI (SUI) has been treated with synthetic mesh through a variety of approaches for >20 years. There have recently been a number of high profile cases highlighting catastrophic complications which has a sparked a pause on all vaginally inserted mesh/tapes to treat SUI/pelvic organ prolapse. We present our experience of managing patients referred with mesh related complications requiring intervention at our national salvage centre.

Patients and materials
Review of prospectively maintained database for patients referred with complications related to mesh insertion between 2012-2018.

Results
In all, 59 patients were identified. Presenting complaints included pain/dyspareunia (n=17), voiding dysfunction (n=12), LUTS/incontinence (n=11), recurrent UTI's (n=7), visible vaginal erosion (n=7), bladder stone (n=2) and haematuria (n=3). Erosion had occurred in 43 cases (27 vaginal, 8 urethral and 7 bladder). Patients were discussed in the Pelvic Floor MDT and reported to HMRA. Majority had their initial incontinence procedure in other units. Salvage procedures performed included; Laparoscopic & cystoscopic assisted excision of eroded mesh +/- fistula repair (one required laparotomy), total excision of vaginal part of tape +/- Martius vaginal flap. Recurrent SUI after salvage surgery occurred in 23% of patients, with the majority treated successfully with autologous pubovaginal slings or Bulkamid.

CONCLUSION

Our centre follows NHS England Mesh group, British Association of Urological Surgeons (BAUS) and British Society of Urogynaecology (BSUG) recommendations. Such complications can result in disabling and catastrophic consequences and should be managed in specialist centres and streamline management plans.
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