Native Tissue Repair After Failed Synthetic Materials

  • A. Lenore Ackerman
  • Seth A. Cohen
  • Shlomo RazEmail author


In the setting of an emerging patient population suffering from recurrent pelvic floor symptoms after mesh removal, the principles and practices of native tissue repair have taken on a new, ever-important position in vaginal reconstructive surgery. This chapter provides a case-study of a patient who undergoes complex mesh removal, with improvement in her constellation of presenting symptoms. Although she improves significantly, she goes on to develop recurrent prolapse in the setting of persistent stress urinary incontinence (SUI). Description of her management details techniques for surgical intervention that we have used successfully after mesh removal to treat deficient, attenuated, atrophied, and scarred pelvic floor tissues.


Double-pronged passer Omega sling Spiral sling Fascia lata Perivesical fascia Periurethral fascia Four-corner suspension 

Supplementary material

Video 20.1

Autologous fascia lata cystocele repair (MP4 250475 kb)


  1. 1.
    Barski D, Deng DY. Management of mesh complications after SUI and POP repair: review and analysis of the current literature. Biomed Res Int. 2015;2015:831285.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Abbott S, Unger CA, Evans JM, Jallad K, Mishra K, Karram MM, et al. Evaluation and management of complications from synthetic mesh after pelvic reconstructive surgery: a multicenter study. Am J Obstet Gynecol. 2014;210(2):163 e1–8.Google Scholar
  3. 3.
    Crosby EC, Abernethy M, Berger MB, DeLancey JO, Fenner DE, Morgan DM. Symptom resolution after operative management of complications from transvaginal mesh. Obstet Gynecol. 2014;123(1):134–9.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Unger CA, Abbott S, Evans JM, Jallad K, Mishra K, Karram MM, et al. Outcomes following treatment for pelvic floor mesh complications. Int Urogynecol J. 2014;25(6):745–9.CrossRefPubMedGoogle Scholar
  5. 5.
    Rogo-Gupta L, Grisales T, Huynh L, Rodriguez LV, Raz S. Symptom improvement after prolapse and incontinence graft removal in a case series of 306 patients. Female Pelvic Med Reconstruct Surg. 2015;21(6):319–24.CrossRefGoogle Scholar
  6. 6.
    Ramart P, Ackerman AL, Cohen SA, Kang D, Choi J, Kim JH, et al. Abstract 507: urinary incontinence after suburethral mesh removal requiring anti-incontinence procedure. Neurourol Urodyn. 2015;34(S3):S423–5.Google Scholar
  7. 7.
    Howden NS, Zyczynski HM, Moalli PA, Sagan ER, Meyn LA, Weber AM. Comparison of autologous rectus fascia and cadaveric fascia in pubovaginal sling continence outcomes. Am J Obstet Gynecol. 2006;194(5):1444–9.CrossRefPubMedGoogle Scholar
  8. 8.
    Fitzgerald MP, Mollenhauer J, Brubaker L. Failure of allograft suburethral slings. BJU Int. 1999;84(7):785–8.CrossRefPubMedGoogle Scholar
  9. 9.
    Drake NL, Weidner AC, Webster GD, Amundsen CL. Patient characteristics and management of dermal allograft extrusions. Int Urogynecol J Pelvic Floor Dysfunct. 2005;16(5):375–7.CrossRefPubMedGoogle Scholar
  10. 10.
    Flynn MK, Webster GD, Amundsen CL. Abdominal sacral colpopexy with allograft fascia lata: one-year outcomes. Am J Obstet Gynecol. 2005;192(5):1496–500.CrossRefPubMedGoogle Scholar
  11. 11.
    Ho KL, Witte MN, Bird ET. 8-ply small intestinal submucosa tension-free sling: spectrum of postoperative inflammation. J Urol. 2004;171(1):268–71.CrossRefPubMedGoogle Scholar
  12. 12.
    Giri SK, Hickey JP, Sil D, Mabadeje O, Shaikh FM, Narasimhulu G, et al. The long-term results of pubovaginal sling surgery using acellular cross-linked porcine dermis in the treatment of urodynamic stress incontinence. J Urol. 2006;175(5):1788–92; discussion 93.CrossRefPubMedGoogle Scholar
  13. 13.
    Bent AE. Sling and bulking agent placement procedures. Rev Urol. 2004;6 Suppl 5:S26–46.PubMedPubMedCentralGoogle Scholar
  14. 14.
    Cormio L, Mancini V, Liuzzi G, Lucarelli G, Carrieri G. Cystocele repair by autologous rectus fascia graft: the pubovaginal cystocele sling. J Urol. 2015;194(3):721–7.Google Scholar
  15. 15.
    Le N-B, Baxter ZC, Rogo-Gupta L, Lee U, Morrisroe S, Staack A, et al. A new mesh-less technique to repair cystoceles with both central and lateral defects. J Urol. 2076;185(4), e831.CrossRefGoogle Scholar
  16. 16.
    Cohen SA, Mellano EM, Chaudhry Z, Ackerman AL, Ramart P, Scott VC, et al. Video 15: cystocele repair using autologous iliotibial band. Female Pelvic Med Reconstr Surg. 2015;21(5):S150.Google Scholar
  17. 17.
    Raz S, Twiss CO, Triaca V. Chapter 34. Smith Jr JA, Howards SS, Preminger GM, editors. Hinman’s atlas of urologic surgery. Philadelphia: Elsevier Health Sciences; 2012.Google Scholar

Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  • A. Lenore Ackerman
    • 1
  • Seth A. Cohen
    • 2
  • Shlomo Raz
    • 3
    Email author
  1. 1.Department of Surgery, Division of UrologyUrologic Reconstruction, Urodynamics, and Female Urology, Cedars-Sinai Medical CenterBeverly HillsUSA
  2. 2.Division of Urology and Urologic Oncology, Department of SurgeryPelvic Medicine and Reconstructive SurgeryHopeUSA
  3. 3.Division of Pelvic Medicine and Reconstructive SurgeryFellowship Program in Pelvic Medicine and Reconstructive SurgeryLos AngelesUSA

Personalised recommendations