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Mesh Perforation into a Viscus in the Setting of Pelvic Floor Surgery—Presentation and Management

  • Lower Urinary Tract Symptoms & Voiding Dysfunction (H Goldman and G Badlani, Section Editors)
  • Published:
Current Urology Reports Aims and scope Submit manuscript

Abstract

Perforation of a viscus with a mesh product either during or subsequent to pelvic floor reconstruction can be associated with devastating outcomes. If surgeons are going to place mesh, they also need to be familiar with symptoms concerning for perforation. The index of suspicion should always be present, as these patients can present years after initial mesh placement. The best opportunity for intervention in these serious complications is the first intervention. As bits of mesh are chipped away during attempted interventions, residual mesh fragments become disjointed, frayed, and scarred further, making their removal even more challenging, in addition to traumatizing likely already weakened tissues. This review presents strategies for patient evaluation in the setting of possible mesh perforation, in addition to treatment strategies for urethral, bladder, ureteral, and colonic/rectal injury. Ultimately, the decision as to how much mesh is removed should be based on each patient’s unique presentation.

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Abbreviations

AUGS:

American Urogynecologic Society

CI:

Confidence Interval

FDA:

Food and Drug Administration

h:

hours

ICS:

International Continence Society

IUGA:

International Urogynecological Association

MUS:

Midurethral sling

OR:

Odds ratio

PFDR:

Pelvic Floor Disorders Registry

POP:

Pelvic Organ Prolapse

SUI:

Stress Urinary Incontinence

TEEH:

Transurethral endoscopic excision using the holmium laser

TVM:

Transvaginal Mesh

TOMUS:

Trial of Midurethral Slings

UTI:

Urinary Tract Infections

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Author contributions

All authors equally contributed to this paper with conception and design of the study, literature review, and analysis; drafting and critical revision, and editing; and final approval of the final version.

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Authors and Affiliations

  1. Division of Urology and Urologic Oncology, Department of Surgery, City of Hope, 412 W. Carroll Ave., Suite 200, Glendora, CA, 91741, USA

    Seth A. Cohen

  2. Glickman Urological and Kidney Institute, Cleveland Clinic, Lerner College of Medicine, 9500 Euclid Avenue, Mail Code Q10-1, Cleveland, OH, 44195, USA

    Howard B. Goldman

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  1. Seth A. Cohen
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Correspondence to Seth A. Cohen.

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Conflict of Interest

Seth A. Cohen declares no potential conflicts of interest.

Howard B. Goldman is a section editor for Current Urology Reports.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Lower Urinary Tract Symptoms & Voiding Dysfunction

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Cohen, S.A., Goldman, H.B. Mesh Perforation into a Viscus in the Setting of Pelvic Floor Surgery—Presentation and Management. Curr Urol Rep 17, 64 (2016). https://doi.org/10.1007/s11934-016-0621-3

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  • DOI: https://doi.org/10.1007/s11934-016-0621-3

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