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Small intestinal submucosa xenograft to manage lower urinary tract prostheses perforation: a new path?

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Abstract

Introduction and hypothesis

Tapes for stress urinary incontinence (SUI) and meshes for pelvic organ prolapse can result in postoperative complications, such as urethral (UP) or bladder (BP) perforations. Martius fat pad (MFP) is an historic procedure, widely used to treat lower urinary tract (LUT) fistulae. We report our experience with the insertion of the biological small intestinal submucosa (SIS) xenograft as an alternative to MFP in these prosthetic complications.

Methods

We conducted a retrospective, monocentric study which included all patients who underwent SIS insertion during surgical removal of tape/vaginal mesh for UP or BP from 2011 to 2019. Preoperative assessment was based on history, symptoms, physical examination and urethrocystoscopy. Primary outcome was successful repair defined as absence of any LUT defect. Secondary outcomes were complications, LUT symptoms, pain and additional SUI surgical procedures.

Results

Thirty-eight patients were included. Twenty-six had a UP and eight a BP. In four cases, perforation involved both the bladder neck and urethra. All LUT defects were cured. Six postoperative complications were reported (five of grade ≤ 2 and one of grade 3b according to the Clavien-Dindo classification). At the mean follow-up of 37.2 (range 6–98) months, 14 patients (36.8%) presenting a postoperative SUI underwent a SUI surgical procedure and 1 patient had a laparoscopic sacrocolpopexy for cystocele recurrence.

Conclusion

Absorbable SIS xenograft is an effective and safe graft for the management of lower urinary tract tape and mesh perforations. The cost has to be balanced with the good results, short operative time and no fat pad complications as in MFP.

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Abbreviations

SUI:

Stress urinary incontinence

POP:

Pelvic organ prolapse

TMC:

Tape/mesh complication

IUGA/ICS C:

International Urogynecological Association/International Continence Society classification

TMR:

Tape/mesh removal

UP:

Urethral perforation

BP:

Bladder perforation

LUT:

Lower urinary tract

MFP:

Martius fat pad

SIS:

Small intestinal submucosa

UUI:

Urge urinary incontinence

UTI:

Urinary tract infections

BNP:

Bladder neck perforation

MUI:

Mixed urinary incontinence

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Acknowledgements

Authors wish to acknowledge Elodie Menechal, secretary in functional urology, for her technical assistance in data collection, Tarek Ghoneim, MD, for English proofreading and Caroline Pettenati, MD, for manuscript comments.

Funding

This study did not receive funding.

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Authors and Affiliations

  1. Department of Urology, Foch Hospital, 40 Rue Worth, 92150, Suresnes, France

    Florence Cour, Pierre Munier, Kevin Kaulanjan, Adrien Vidart, Pierre-Olivier Bosset & Yann Neuzillet

  2. University of Versailles-Saint-Quentin-en-Yvelines, Versailles, France

    Yann Neuzillet

Authors
  1. Florence Cour
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  2. Pierre Munier
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  3. Kevin Kaulanjan
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Contributions

F Cour: Project development, Data collection, Data analysis, Manuscript writing.

P Munier: Data collection, Manuscript writing.

K Kaulanjan: Data collection.

A Vidart: Project development.

PO Bosset: Project development.

Y Neuzillet: Manuscript editing.

Corresponding author

Correspondence to Florence Cour.

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Conflict of interest

Florence Cour, Pierre Munier and Kevin Kaulanjan declare that they have no conflict of interest.

Adrien Vidart is a consultant for Boston Scientific.

Pierre-Olivier Bosset is a consultant for Janssen and da Vinci.

Yann Neuzillet has accepted paid travel expenses and has received a speaker honorarium from Astellas, Merck Sharp and Dohme and Ipsen; he is a consultant for AstraZeneca, Bayer, Bristol-Myers Squibb, Sanofi.

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Cour, F., Munier, P., Kaulanjan, K. et al. Small intestinal submucosa xenograft to manage lower urinary tract prostheses perforation: a new path?. Int Urogynecol J 33, 627–635 (2022). https://doi.org/10.1007/s00192-021-04771-5

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  • DOI: https://doi.org/10.1007/s00192-021-04771-5

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