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Vijay K, Kelley L, Pak T, Kuhlmann P, Patterson-Lachowicz A, Fetzer DT, Reynolds L, Carmel M, Zimmern P, Khatri G. Multimodality Imaging of Anterior Compartment Pelvic Floor Repair. Radiographics 2023; 43:e230032. [PMID: 37498784 DOI: 10.1148/rg.230032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Pelvic organ prolapse (POP) and stress urinary incontinence (SUI) are two common disorders that affect the anterior compartment of the pelvic floor in women. These can be treated conservatively or surgically. Among patients treated surgically, a substantial number present with pain, recurrent POP or SUI, or other conditions that warrant additional interventions. In many of these cases, imaging is key to identifying and characterizing the type of procedure performed, locating synthetic materials that may have been placed, and characterizing complications. Imaging may be particularly helpful when prior surgical records are not available or a comprehensive physical examination is not possible. US and MRI are the most commonly used modalities for such patients, although radiopaque surgical materials may be visible at voiding cystourethrography and CT. The authors summarize commonly used surgical treatment options for patients with SUI and POP, review imaging techniques for evaluation of such patients, and describe the normal imaging appearance and complications of pelvic floor surgical repair procedures in the anterior compartment of the pelvis. ©RSNA, 2023 Quiz questions for this article are available in the supplemental material.
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Affiliation(s)
- Kanupriya Vijay
- From the Departments of Radiology (K.V., L.K., T.P., A.P.L., D.T.F., L.R., G.K.) and Urology (P.K., M.C., P.Z.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75234
| | - Layne Kelley
- From the Departments of Radiology (K.V., L.K., T.P., A.P.L., D.T.F., L.R., G.K.) and Urology (P.K., M.C., P.Z.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75234
| | - Taemee Pak
- From the Departments of Radiology (K.V., L.K., T.P., A.P.L., D.T.F., L.R., G.K.) and Urology (P.K., M.C., P.Z.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75234
| | - Paige Kuhlmann
- From the Departments of Radiology (K.V., L.K., T.P., A.P.L., D.T.F., L.R., G.K.) and Urology (P.K., M.C., P.Z.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75234
| | - Amber Patterson-Lachowicz
- From the Departments of Radiology (K.V., L.K., T.P., A.P.L., D.T.F., L.R., G.K.) and Urology (P.K., M.C., P.Z.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75234
| | - David T Fetzer
- From the Departments of Radiology (K.V., L.K., T.P., A.P.L., D.T.F., L.R., G.K.) and Urology (P.K., M.C., P.Z.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75234
| | - Laura Reynolds
- From the Departments of Radiology (K.V., L.K., T.P., A.P.L., D.T.F., L.R., G.K.) and Urology (P.K., M.C., P.Z.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75234
| | - Maude Carmel
- From the Departments of Radiology (K.V., L.K., T.P., A.P.L., D.T.F., L.R., G.K.) and Urology (P.K., M.C., P.Z.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75234
| | - Philippe Zimmern
- From the Departments of Radiology (K.V., L.K., T.P., A.P.L., D.T.F., L.R., G.K.) and Urology (P.K., M.C., P.Z.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75234
| | - Gaurav Khatri
- From the Departments of Radiology (K.V., L.K., T.P., A.P.L., D.T.F., L.R., G.K.) and Urology (P.K., M.C., P.Z.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75234
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Lou Y, Hu Y, Zhou Y. Pelvic ultrasound finding of late-onset bladder erosion after transobturator tape for female stress urinary incontinence: A case report. Medicine (Baltimore) 2023; 102:e33129. [PMID: 36862893 PMCID: PMC9981393 DOI: 10.1097/md.0000000000033129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
RATIONALE Mid-urethral sling is a gold-standard procedure for stress urinary incontinence because of its high efficacy and low complication incidence. Moreover, mesh erosion into the bladder is a rare complication. PATIENT CONCERNS The 63-year-old patient visited our gynecology clinic with complaints of gross hematuria and was diagnosed with bladder erosion by ultrasound 6 months after transobturator tape procedure. DIAGNOSES The 2D ultrasound found the sling in the bladder wall perforation, which can lead to the formation of bladder stones. Meanwhile, 3D ultrasound showed the left side of the sling crossed the bladder mucosa at 5 o'clock. INTERVENTIONS The sling and bladder stones were removed by holmium laser. OUTCOMES The patient underwent a follow-up pelvic ultrasound at 6 months, which showed no erosion mesh under the bladder mucosa. LESSONS Pelvic ultrasound could accurately evaluate the location and shape of the tape, which is important for a reasonable surgical plan.
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Affiliation(s)
- Yelin Lou
- Department of Ultrasonography, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - Yang Hu
- Department of Urology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
- * Correspondence: Yang Hu, Department of Urology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua 321000, China (e-mail: )
| | - Yibo Zhou
- Department of Ultrasonography, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
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Zhou Q, Lu M, Li GS, Peng GL, Song YF. Knowledge mapping and visualization analysis of pelvic organ prolapse repair with mesh from 2001 to 2021. Front Bioeng Biotechnol 2023; 11:1104724. [PMID: 37091336 PMCID: PMC10113510 DOI: 10.3389/fbioe.2023.1104724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/22/2023] [Indexed: 04/25/2023] Open
Abstract
Aims: In recent decades, extensive attention has been paid to the application of mesh to repair pelvic floor defects. However, a large body of related literature has not been system summarized. The purpose of this study is to summarize and visualize the literature on pelvic organ prolapse (POP) repair with mesh using bibliometrics. Methods: Medical literature regarding POP repair with mesh were searched and obtained in the Web of Science™ Core (WoSCC) database from 2001 to 2021. Microsoft Excel 2020, CiteSpace and VOSviewer were used to conduct the bibliometric and knowledge-map analysis. Results: In the past 20 years, a total of 2,550 articles and reviews have been published in 35 journals, and the published and cited results show a growing trend. Cosson M and International Urogynecology Journal were the authors and journals with the highest output, respectively. The United States, France and the United Kingdom are among the top three countries/organizations in relevant publications in worldwide. 584 key words in the literature are divided into 8 clusters, which are mainly related to prolapse type, risk factors, surgical methods, imaging, quality of life and bioengineering. Using clinical research and tissue engineering technology to reduce mesh complications is the current hot spot in this field. Conclusion: Reasonable application of mesh and avoiding mesh complications are still the most concerned topics in POP research. Although clinical research, surgical improvement, biological mesh and bioengineering technology have shown promising results, it is still urgent to carry out clinical transformation application research.
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Affiliation(s)
- Quan Zhou
- Department of Gynecology and Obstetrics, The People’s Hospital of China Three Gorges University/The First People’s Hospital of Yichang, Yichang, China
- Department of Gynecology and Obstetrics, The 900th Hospital of Joint Logistic Support Force, Fuzhou, Fujian, China
- *Correspondence: Quan Zhou, ; Yan-Feng Song,
| | - Man Lu
- Department of Gynecology and Obstetrics, The People’s Hospital of China Three Gorges University/The First People’s Hospital of Yichang, Yichang, China
| | - Guo-Sheng Li
- Department of Gynecology and Obstetrics, The People’s Hospital of China Three Gorges University/The First People’s Hospital of Yichang, Yichang, China
| | - Gan-Lu Peng
- Department of Gynecology and Obstetrics, The People’s Hospital of China Three Gorges University/The First People’s Hospital of Yichang, Yichang, China
| | - Yan-Feng Song
- Department of Gynecology and Obstetrics, The 900th Hospital of Joint Logistic Support Force, Fuzhou, Fujian, China
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Krishnaswamy PH, Boodhoo VH, McNeil J, Tyagi V, Guerrero KL. Use of Magnetic Resonance Imaging in women with suspected complications following insertion of implants for pelvic organ prolapse and stress urinary incontinence surgery. Eur J Obstet Gynecol Reprod Biol 2022; 273:44-53. [PMID: 35462213 DOI: 10.1016/j.ejogrb.2022.03.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/05/2022] [Accepted: 03/29/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the role of Magnetic Resonance Imaging (MRI) in women presenting with suspected implant complications following surgery for pelvic organ prolapse (POP) and stress urinary incontinence (SUI). STUDY DESIGN Retrospective single-centre cohort study in a designated tertiary referral centre. All women with vaginally and/or abdominally placed implants for POP or SUI who were referred with suspected mesh complications, and investigated with an MRI scan, between January 2018-October 2020 were included in the study. RESULTS 97 women were identified over this time-period with a total of 123 implants, a median age of 55 years (Range: 34-79) and an average insertion to presentation time of 84 months (Range: 2-300). 78% (74) had one implant in situ, with the remainder having at least 2 in situ. Transobturator tapes (TVT-O/TOT) were the most common implants [35% (43)]. Chronic Pelvic or abdominal pain was the most common clinical symptom [73.2% (71/112 primary complaints)] with provoked tenderness on examination being the most common clinical finding [27.8% (32/115 clinical findings)]. MRI was more likely to detect abdominally placed implants [100% (all 30)] and Retropubic Tapes [89% (16/18)] when compared to Transvaginal POP implants [87.5% (28/32)] and TVT-O/TOT [67% (29/43)]. MRI identified both cases of Sacrocolpopexy mesh rupture as well as all 11 cases of infection (100%). In 91% (10/11) of these cases, MRI revealed the infection to be more widespread than clinical findings initially suspected. Cohen's Kappa demonstrated excellent correlation between MRI and surgical findings in cases with implant related infection, rupture and normal findings (κ = 1; z = 4.58; p = 0.00000459). CONCLUSION(S) MRI can be a useful tool in assessment and management of patients with complications from implants. MRI can detect infection that may be more extensive that is initially clinically apparent in the outpatient setting. Abdominal implants appear to be easier to detect than transvaginal meshes and trans obturator tapes.
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Affiliation(s)
- Priyanka H Krishnaswamy
- Subspecialty Registrar in Urogynaecology, Queen Elizabeth University Hospital, Glasgow G51 4TF, United Kingdom.
| | - Vijna Hiteshna Boodhoo
- Core Surgical Trainee, Department of General Surgery, Barnsley Hospital, Gawber Road, Barnsley S75 2EP, United Kingdom
| | - Joanna McNeil
- Consultant Radiologist, Queen Elizabeth University Hospital, Glasgow G51 4TF, United Kingdom
| | - Veenu Tyagi
- Subspecialist Urogynaecology Consultant, Queen Elizabeth University Hospital, Glasgow G51 4TF, United Kingdom
| | - Karen Lesley Guerrero
- Subspecialist Urogynaecology Consultant, Queen Elizabeth University Hospital, Glasgow G51 4TF, United Kingdom
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Management of Vaginal Mesh Exposures Following Female Pelvic Reconstructive Surgery. Curr Urol Rep 2020; 21:57. [PMID: 33125530 DOI: 10.1007/s11934-020-01002-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE OF REVIEW To discuss considerations and current evidence for the diagnosis and management of vaginal mesh exposures following female mesh-augmented anti-incontinence and pelvic organ prolapse surgery. RECENT FINDINGS Since the introduction of mesh into female pelvic surgery, various applications have been reported, each with their own unique risk profile. The most commonly encountered mesh-related complication is vaginal mesh exposure. Current evidence on the management of vaginal mesh exposure is largely limited to observational studies and case series, though this is continuing to expand. We present a synthesis of the available data, as well as clinical and surgical approaches to managing this complication. It is important for surgeons to be familiar with the management of vaginal mesh exposures. Depending on the patient's presentation and goals, there is a role for conservative measures, mesh revision, or mesh excision. Further study is warranted to standardize mesh resection techniques and explore non-surgical treatments.
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Patnam R, Husk K, Sripad A, Barletta K, Dieter A, Geller EJ. Effect of BMI on clinical outcomes following minimally invasive sacrocolpopexy. J Robot Surg 2020; 15:63-68. [PMID: 32300933 DOI: 10.1007/s11701-020-01079-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 04/07/2020] [Indexed: 02/04/2023]
Abstract
Our objective was to compare success and complication rates following minimally invasive sacrocolpopexy (SCP) based on body mass index (BMI). This is a retrospective cohort study of women who underwent laparoscopic or robotic SCP at one academic center from 2006 to 2016. Women were included if they had a postoperative pelvic organ prolapse quantification (POPQ) exam and subjective success documented. For our primary outcome, we compared composite success (POPQ stage ≤ I and report of no bulge symptoms) amongst three groups: normal weight (BMI ≤ 25), overweight (BMI 25-30) and obese (BMI ≥ 30) women. Secondary outcomes included intraoperative complications, 6 week postoperative complications, and sacrocolpopexy mesh exposure. Of the 431 women who met inclusion criteria, 140 (32%) had normal BMI (23 kg/m2; IQR 22, 24), 177 (41%) were overweight (27 kg/m2; IQR 26, 28), and 114 (26%) were obese (32 kg/m2; IQR 31, 36). Mean age was 60 ± 11 years, and most were Caucasian, with no differences in demographics or Charlson Comorbidity Index (CCI). Median length of follow-up was 49 weeks (IQR 9, 104), with similar follow-up for all groups. For our primary outcome, composite success was 72% overall, with no significant differences in composite success rates between groups. For secondary outcomes, there were no differences in the rates of perioperative complications but obese women had a 2.8 increased risk of mesh exposure (p = 0.02). Obesity was not associated with differences in the success or peri-operative complication rates for SCP in our population, but was associated with mesh exposure.
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Affiliation(s)
- Radhika Patnam
- Division of Urogynecology and Reconstructive Pelvic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, 3032 Old Clinic Building, CB#7570, Chapel Hill, NC, 27599-7570, USA
| | - Katherine Husk
- Division of Urogynecology and Reconstructive Pelvic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, 3032 Old Clinic Building, CB#7570, Chapel Hill, NC, 27599-7570, USA
| | - Abhishek Sripad
- Division of Urogynecology and Reconstructive Pelvic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, 3032 Old Clinic Building, CB#7570, Chapel Hill, NC, 27599-7570, USA
| | - Kathryn Barletta
- Division of Urogynecology and Reconstructive Pelvic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, 3032 Old Clinic Building, CB#7570, Chapel Hill, NC, 27599-7570, USA
| | - Alexis Dieter
- Division of Urogynecology and Reconstructive Pelvic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, 3032 Old Clinic Building, CB#7570, Chapel Hill, NC, 27599-7570, USA
| | - Elizabeth J Geller
- Division of Urogynecology and Reconstructive Pelvic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, 3032 Old Clinic Building, CB#7570, Chapel Hill, NC, 27599-7570, USA. .,Division of Female Pelvic Medicine and Reconstructive Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, CB#7570, Chapel Hill, NC, 27599-7570, USA.
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3D modeling and 3D printing in functional urology: the future perspective. Int Urogynecol J 2020; 31:1977-1978. [DOI: 10.1007/s00192-020-04286-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 03/13/2020] [Indexed: 12/28/2022]
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