Severe mesh complications following intravaginal slingplasty.

OBJECTIVE: Synthetic meshes are increasingly used in the management of stress urinary incontinence and pelvic organ prolapse. This report describes severe complications following anterior and/or posterior intravaginal slingplasties employing a multifilament polypropylene mesh. METHODS: We describe the symptoms, findings, subsequent management, and outcome of 19 consecutive women who have been referred with complications following anterior (n = 11) and/or posterior intravaginal slingplasty (n = 13) employing the multifilament polypropylene tape. RESULTS: The main indications for removal of the 11 anterior intravaginal slings were intractable mesh infection in 6 women, retropubic abscess with cutaneous sinus in one, and vesico-vaginal fistula in one, intravesical mesh and pain syndrome in one, and voiding difficulties and pain syndrome in two. The main indications for removal of the 13 posterior intravaginal slings were intractable mesh infection in three and pain syndrome and dyspareunia in 10 women. Removal of the slings was performed after a median time of 24 months post-slingplasty. At follow-up between 6 weeks and 6 months, in all women genital pain, chronic vaginal discharge and bleeding, voiding, and defecation difficulties had been markedly alleviated (5) or they had ceased (14). Twelve of 17 sexually active women (71%) resumed sexual intercourse without difficulties. Ten women required subsequent surgery for stress incontinence and pelvic organ prolapse. CONCLUSION: Surgeons should be aware of the potential complications of synthetic meshes. Until data on the safety and efficacy of the intravaginal slingplasties are available, these procedures cannot be recommended.

Simplified colposuspension: a 15-year follow-up.

AIM: Retrospective analysis of long-term results of a simplified 'Burch type' colposuspension. METHODS: A retrospective chart review, with follow-up through postal questionnaires sent in September 2000, of all 374 patients who had a simplified colposuspension between 1985 and 1998, with additional total abdominal hysterectomy in 103 patients. Outcome measures were patient satisfaction, complications and recovery. RESULTS: The mean period of follow-up was 9.2 years. Response rate to the questionnaire was 85% with 51.5% of patients very satisfied with the surgery, 17.4% moderately satisfied and 12.6% having some symptomatic relief. Complications developed in 31.3% but few were serious. Average hospitalisation was 5.8 days. The mean time to establishment of normal voiding was 58.5 h. The average length of catheterisation was 49.9 h, with only seven patients requiring prolonged catheterisation. Seventy-four patients required additional surgery for de novo, persistent or recurring symptoms. CONCLUSIONS: The present study provides evidence that a simplified Burch type colposuspension provides a satisfactory cure rate on long-term follow-up and is associated with earlier resumption of normal voiding. Transurethral drainage remains a simple and effective method of bladder management after colposuspension. The present study also confirms that many patients do need further pelvic floor surgery for later development of deficiencies in the pelvic floor.