Surgical management of bladder erosion and pelvic pain after laparoscopic lateral suspension for pelvic organ prolapse
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IUJ VIDEO
Surgical management of bladder erosion and pelvic pain after laparoscopic lateral suspension for pelvic organ prolapse Rodolfo Milani 1 & Stefano Manodoro 2
&
Paolo Passoni 1 & Luca Locatelli 1 & Marta Barba 1 & Matteo Frigerio 1
Received: 19 December 2019 / Accepted: 11 February 2020 # The International Urogynecological Association 2020
Abstract Introduction and hypothesis Mesh-augmented lateral suspension for prolapse repair seems to be associated with few complications. However, mesh-related complications can negatively affect the quality of life and may be challenging to manage. This video is aimed at presenting the surgical management of a case of severe pelvic pain and dyspareunia after lateral laparoscopic suspension associated with mesh erosion in the bladder. Methods A 46-year-old woman was referred to our Unit for severe pelvic pain and inability to have sexual intercourses since undergoing a uterus-sparing laparoscopic lateral suspension procedure for genital prolapse 2 years before in another hospital. Moreover, she reported bladder pain and recurrent urinary tract infections. Cystoscopy showed mesh erosion in the bladder. She was admitted to laparoscopic hysterectomy plus subtotal mesh excision and bladder reconstruction (video). Results No surgical complications were observed. The postoperative course was uneventful. At the current follow-up, the patient reported complete resolution of her symptoms. Conclusion The featured video shows laparoscopic subtotal mesh excision, concomitant hysterectomy and bladder repair for pelvic pain, dyspareunia and bladder erosion after lateral suspension. This video may be useful in providing anatomical views and surgical steps necessary for achieving successful surgical management of this mesh-related complication. Keywords Mesh-related complication . Dyspareunia . Video tutorial . Pelvic organ prolapse . Surgery . Bladder erosion
Introduction Surgical repair represents the milestone of prolapse treatment. The principal issue with native-tissue repair is the recurrence rate, which has been associated with several risk factors, including population characteristics, obstetric history, prolapse stage, histological findings, and additional surgical procedures performed [1, 2]. As a consequence, the use of mesh has
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00192-020-04261-0) contains supplementary material. This video is also available to watch on http://link.springer. com/. Please search for this article by the article title or DOI number, and on the article page click on ‘Supplementary Material’ * Stefano Manodoro [email protected]
gained popularity over the past decades to reduce recurrences. Unfortunately, extensive mesh implantation resulted in the rise of specific complications such as exposure, pain, and fistula formation [3–5]. These complications are thought to be related to post-implantation tension induced by mesh contraction and can require multiple reoperations [6]. After the 2011
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