With the aging of our population, pelvic organ prolapse is an increasingly common condition that negatively affects patient quality of life. Vaginal vault prolapse has been reported to occur in as many as 18.2% of all women with prolapse, and many would suggest that vaginal vault prolapse is a component of most high-grade anterior compartment descensus. Several repairs exist that reconstitute support to the vaginal apex, and certainly there is no single procedure that is optimal for all patients. Abdominal sacral colpopexy (ASC) offers an effective and durable repair for vaginal vault prolapse. It maximizes functional vaginal length and approximates the normal vaginal axis. ASC should be considered especially in patients with failed prior vaginal repairs, isolated high-grade apical prolapse, and in younger patients with apical prolapse who would like to maintain sexual function. The procedure may be performed open, laparoscopic, or robotically assisted. In our experience, the key components of the operation though the open or robotic approach include utilization of a permanent, type I macroporous mesh, secure suture fixation of the graft to the sacral promontory and vaginal cuff, complete enterocele reduction and culdoplasty, and the addition of concomitant anti-incontinence procedures as indicated. We affix the vaginal portion of the graft with multiple sutures to distribute the tension evenly over the vaginal apex, and avoid excessive tension between the apex and sacrum. We routinely close the peritoneum over the mesh arm. In this chapter, we will address the recognition and management of complications potentially associated with this method of the repair, as well as outline complications that have arisen from other variations.

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Female Incontinence: Therapy I1 Apr 2017MP40-16 OUTCOMES OF TREATMENT OF STRESS URINARY INCONTINENCE ASSOCIATED WITH FEMALE URETHRAL DIVERTICULA: A SELECTIVE APPROACH Alyssa Greiman, Lauren Rittenberg, Drew Freilich, Ross Rames, Ahmed El-Zawahry, Michelle Koski, and Eric Rovner Alyssa GreimanAlyssa Greiman More articles by this author , Lauren RittenbergLauren Rittenberg More articles by this author , Drew FreilichDrew Freilich More articles by this author , Ross RamesRoss Rames More articles by this author , Ahmed El-ZawahryAhmed El-Zawahry More articles by this author , Michelle KoskiMichelle Koski More articles by this author , and Eric RovnerEric Rovner More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1263AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Female urethral diverticula (UD) may present with a variety of different symptoms including stress urinary incontinence (SUI). Surgical repair of SUI may be done concomitantly with urethral diverticulectomy. However, some surgeons may be reluctant to repair SUI at the time of urethral diverticulectomy due to the additional surgical time and potential morbidity of anti-incontinence surgery. We assessed surgical outcomes of the concomitant treatment of SUI at the time of transvaginal urethral diverticulectomy (TVUD) based on a selective approach. METHODS Following IRB approval, we identified patients with a UD and SUI who underwent TVUD between July 2004 and January 2016. SUI was documented before and after surgery using subjective and objective parameters. Autologous pubovaginal slings (APVS) were used selectively based on surgeon and patient preference. Postoperatively, the majority of patients were imaged prior to catheter removal with voiding-cystourethrogram. RESULTS A total of 61 patients underwent surgical treatment of urethral diverticula. There were 39 patients with UD and concomitant SUI. Mean age was 53 years (range 34-77). There were 22 Caucasians, and 17 African American patients. Mean follow-up was 16.2 months (range 1-72 months). There were 24 patients (62%) with SUI that underwent concomitant APVS. Of these 24 patients, 10 (42%) had prior SUI surgery. There was resolution of SUI in 20 of 24 patients (83%) who underwent a simultaneous APVS compared to 8 of 15 patients (53%) who underwent TVUD without APVS (2 patients lost to follow-up). One patient out of 22 developed de-novo SUI following TVUD. Surgery resulted in the improvement or resolution of the majority of preoperative symptoms including recurrent urinary tract infection (UTI) (82% vs. 15%), dyspareunia (64% vs. 8%), and urgency (56% vs. 13%) (preoperative vs. postoperative). Complications included two patients with prolonged urinary retention following APVS requiring sling lysis. There were 2 patients with a recurrent UD, one of which required repair 18 months post-operatively. CONCLUSIONS Female UD is often associated with SUI. Surgical reconstruction of UD often results in satisfactory control of urinary symptoms including SUI when both are treated concomitantly in those with bothersome symptoms. Treatment of SUI with APVS when undergoing TVUD is feasible with satisfactory outcomes. The decision whether or not to perform concomitant APVS at time of TVUD should be made on an individual basis after appropriate counseling. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e529 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Alyssa Greiman More articles by this author Lauren Rittenberg More articles by this author Drew Freilich More articles by this author Ross Rames More articles by this author Ahmed El-Zawahry More articles by this author Michelle Koski More articles by this author Eric Rovner More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

AIMS:To assess surgical outcomes of concomitant treatment of SUI at time of transvaginal urethral diverticulectomy (TVUD) based on a selective approach.METHODS:Following Institutional Review Board (IRB) approval, we identified patients with a UD and SUI who underwent TVUD between July 2004 and January 2016. SUI was documented before and after surgery using subjective and objective parameters. Autologous pubovaginal slings (APVS) were used selectively based on surgeon and patient preference.RESULTS:A total of 61 patients underwent surgical treatment of urethral diverticula; 39 patients with UD and concomitant SUI. Mean age was 53 years. Mean follow-up was 16.2 months. There were 24 patients (62%) with SUI that underwent concomitant APVS. There was resolution of SUI in 20 of 24 patients (83%) who underwent a simultaneous APVS compared to 8 of 15 patients (53%) who underwent TVUD without APVS. Surgery resulted in the improvement or resolution of the majority of preoperative symptoms including recurrent urinary tract infection (UTI) (82% vs 15%), dyspareunia (64% vs 8%), and urgency (56% vs 13%) (preoperative vs postoperative).CONCLUSIONS:Female UD is often associated with SUI. Concomitant surgical treatment of UD and SUI often results in satisfactory control of bothersome SUI as well as other urinary symptoms such as UTI, dyspareunia and urgency. Treatment of SUI with APVS when undergoing TVUD is feasible with satisfactory outcomes.

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Female Urology1 Apr 2015MP81-13 OUTCOMES OF TREATMENT OF STRESS URINARY INCONTINENCE ASSOCIATED WITH FEMALE URETHRAL DIVERTICULA Drew Freilich, Ross Rames, Ahmed El-Zawahry, Eric Rovner, and Michelle Koski Drew FreilichDrew Freilich More articles by this author , Ross RamesRoss Rames More articles by this author , Ahmed El-ZawahryAhmed El-Zawahry More articles by this author , Eric RovnerEric Rovner More articles by this author , and Michelle KoskiMichelle Koski More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2891AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Female urethral diverticula (UD) may present with a variety of different symptoms including stress urinary incontinence (SUI). Surgical repair of SUI may be done concomitantly with urethral diverticulectomy. However, some surgeons may be reluctant to repair SUI at the time of urethral diverticulectomy due to the additional surgical time and potential morbidity of anti-incontinence surgery. We assessed surgical outcomes of the concomitant treatment of SUI at the time of transvaginal urethral diverticulectomy (TVUD). METHODS Following IRB approval, we identified patients with a UD and SUI who underwent TVUD between 2004 and 2014. SUI was documented before and after surgery using subjective and objective parameters. Martius flap and/or autologous pubovaginal fascial slings (APVS) were used selectively based on surgeon and patient preference. Postoperatively, all patients were imaged prior to catheter removal with voiding-cystourethrogram. RESULTS There were 35 pts (65%) with UD and concomitant SUI. Mean age was 52 years (range 34-77). There were 18 Caucasians, 17 African American. Mean follow-up was 15.4 months (Range 0-72). 22/35 patients with SUI underwent APVS concomitant to TVUD. Of these 22 patients, 4 had prior SUI surgery. 77% of patients who underwent a simultaneous APVS at the time of TVUD had resolution of SUI. 7 of 11 patients who underwent TVUD without APVS had resolution of SUI postoperatively (2 patients were lost to follow up). Five developed de-novo SUI following TVUD. Surgery resulted in the improvement or resolution of the majority of preoperative symptoms including recurrent urinary tract infection (UTI) (77% vs. 11%), dyspareunia (63% vs. 6%), and urgency (49% vs. 14.3%) (preoperative vs. postoperative). Complications included two patients with prolonged urinary retention following APVS requiring sling lysis. There was one patient with a recurrent UD 18 months postoperatively. CONCLUSIONS SUI is often associated with female UD. Surgical reconstruction of UD often results in satisfactory control of urinary symptoms including SUI when both are treated concomitantly. Treatment of SUI with APVS when undergoing TVUD is feasible with satisfactory outcomes. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e1033-e1034 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Drew Freilich More articles by this author Ross Rames More articles by this author Ahmed El-Zawahry More articles by this author Eric Rovner More articles by this author Michelle Koski More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Female Urology II1 Apr 2014MP75-19 STRESS URINARY INCONTINENCE OUTCOMES FOLLOWING TRANSVAGINAL SLING INCISION Lara MacLachlan, Justin Ellett, Kelly Johnson, Gini Ikwuezunma, Michelle Koski, Ross Rames, Ahmed El-Zawahry, and Eric Rovner Lara MacLachlanLara MacLachlan More articles by this author , Justin EllettJustin Ellett More articles by this author , Kelly JohnsonKelly Johnson More articles by this author , Gini IkwuezunmaGini Ikwuezunma More articles by this author , Michelle KoskiMichelle Koski More articles by this author , Ross RamesRoss Rames More articles by this author , Ahmed El-ZawahryAhmed El-Zawahry More articles by this author , and Eric RovnerEric Rovner More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2392AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Mid-urethral slings (MUS) have been commonly used in the operative management of stress urinary incontinence (SUI). Unfortunately, many women suffer from complications following MUS surgery that may necessitate a subsequent surgery such as a transvaginal sling incision (TVSI). The objective of this study is to assess the SUI outcomes following TVSI. METHODS A retrospective review of patients who underwent TVSI from 2007 to 2013 was conducted. Indications for the surgery included bladder outlet obstruction (BOO), pelvic pain, dyspareunia, transvaginal exposure of mesh and erosion of mesh into the urinary tract. SUI at baseline and at 3 months follow-up was assessed. SUI was defined as any patient-reported symptoms of SUI, or demonstration of SUI on physical exam, or urodynamic examination. RESULTS A total of 167 patients underwent TVSI with the most common indication being BOO (67.7%). Of the entire cohort, 88/167 (52.7%) had no SUI at baseline and following TVSI 26.1% of these patients had SUI at 3 months follow-up. Of the 113 patients with BOO at presentation, 67 (59.3%) patients had no SUI at baseline and 16/67 (23.9%) patients had SUI at 3 months follow-up. 17/39 (43.6%) patients with transvaginal mesh exposure had no SUI at baseline and 23.5% of these patients had SUI following TVSI. Of the 23 patients with mesh erosion into the urinary tract, 11 (47.8%) patients had no SUI at baseline and 6/11 (54.5%) patients had SUI at 3 months. Of the 66 patients with pelvic pain, 10/30 (33.3%) patients had SUI following TVSI who did not have SUI at baseline. Of the 78 patients with dyspareunia, 10/34 (29.4%) who did not have SUI at baseline had SUI following TVSI. There were 46 patients with SUI and BOO at baseline and following TVSI, 21 patients (45.7%) continued to have SUI at 3 months. Of the 33 patients with SUI and no BOO at baseline, concomitant slings were done on 5 patients at the time of TVSI (2 MUS and 3 autologous pubovaginal slings (aPVS). One patient with concomitant MUS had SUI at 3 months and no patient with a concomitant aPVS had SUI at 3 months. 19 patients have undergone subsequent SUI surgery or bulking injection (11 aPVS, 3 MUS, 2 bladder neck closures, and 3 bulking agents). CONCLUSIONS For patients who do not have SUI at baseline, recurrent SUI following TVSI is not commonly seen. However, for those patients with mesh erosion into the urinary tract or SUI at presentation, recurrent/persistent SUI is seen in over 50% of patients. This knowledge can be used in counseling patients who undergo TVSI. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e881 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Lara MacLachlan More articles by this author Justin Ellett More articles by this author Kelly Johnson More articles by this author Gini Ikwuezunma More articles by this author Michelle Koski More articles by this author Ross Rames More articles by this author Ahmed El-Zawahry More articles by this author Eric Rovner More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

The release of the U. S. Food and Drug Administration (FDA) safety communication on the use of transvaginal mesh (TVM) for pelvic organ prolapse (POP) has resulted in changes in the pelvic reconstruction community. This monograph reviews the implications of the FDA statements over the last 1824 months. Recent findings show that there have been significant developments in the areas of regulatory mandates, media and medicolegal activity, and statements from surgical societies. In summary, wellpublicized communications from the FDA and major medical organizations are defining a change in the use of TVM for POP.

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Female Urology II1 Apr 2014MP75-13 SEXUAL DYSFUNCTION AND DYSPAREUNIA IN THE SETTING OF VAGINAL MESH EXPOSURE Lara MacLachlan, Justin Ellett, Kelly Johnson, Gini Ikwuezunma, Michelle Koski, Ross Rames, Ahmed El-Zawahry, and Eric Rovner Lara MacLachlanLara MacLachlan , Justin EllettJustin Ellett , Kelly JohnsonKelly Johnson , Gini IkwuezunmaGini Ikwuezunma , Michelle KoskiMichelle Koski , Ross RamesRoss Rames , Ahmed El-ZawahryAhmed El-Zawahry , and Eric RovnerEric Rovner View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2386AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Transvaginal mesh has been commonly used in the operative management of stress urinary incontinence (SUI) and pelvic organ prolapse (POP). Vaginal mesh exposure is a complication that can result in sexual dysfunction and dyspareunia. The objective of this study is to assess the effect of mesh removal surgery on sexual function. METHODS A retrospective review of patients who underwent explantation of vaginal mesh from 2007 to 2013 was conducted. A total of 191 patients were identified of which 58 patients had evidence of vaginal mesh exposure. 30 patients had mesh slings, 8 patients had POP mesh, and 20 patients had both. Sexual activity and dyspareunia was assessed by patient report via chart review at presentation and at 3 months follow-up. RESULTS Of the cohort, 32 patients were sexually active at presentation despite vaginal mesh exposure and the majority of these women were experiencing dyspareunia (81.3%). 17 of these 32 sexually active patients had a mesh sling, 3 had POP mesh and 12 had both. The sexually active patients were significantly younger with a mean age of 53.6 years (range 26 to 86 years) compared to a mean age of 61.0 years (range 31 to 78 years) for those patients who were not sexually active at presentation (p=0.024). Of the 26 patients who were not sexually active at presentation, 8 (30.7%) were sexually active at 3 months follow-up. Of those 8 patients, two patients experienced dyspareunia. Of the entire cohort 69.0% of patients presented with complaints of dyspareunia. At 3 months, there were only 9/58 (15.5%) patients complaining of dyspareunia, which represents a significant improvement from baseline (p<0.001). CONCLUSIONS This study demonstrates that sexual dysfunction is commonly seen among women with vaginal mesh exposure, and that improvements can be seen following mesh removal surgery. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e878 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Lara MacLachlan More articles by this author Justin Ellett More articles by this author Kelly Johnson More articles by this author Gini Ikwuezunma More articles by this author Michelle Koski More articles by this author Ross Rames More articles by this author Ahmed El-Zawahry More articles by this author Eric Rovner More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Female Urology I1 Apr 2014PD33-12 ANALYSIS OF LUTS AND DYSPAREUNIA IN PATIENTS UNDERGOING TRANSVAGINAL MESH REMOVAL FOR MESH EXPOSURE AND EROSION Lara MacLachlan, Justin Ellett, Kelly Johnson, Gini Ikwuezunma, Michelle Koski, Ross Rames, Ahmed El-Zawahry, and Eric Rovner Lara MacLachlanLara MacLachlan More articles by this author , Justin EllettJustin Ellett More articles by this author , Kelly JohnsonKelly Johnson More articles by this author , Gini IkwuezunmaGini Ikwuezunma More articles by this author , Michelle KoskiMichelle Koski More articles by this author , Ross RamesRoss Rames More articles by this author , Ahmed El-ZawahryAhmed El-Zawahry More articles by this author , and Eric RovnerEric Rovner More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2295AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Transvaginal mesh has been commonly used in the operative management of stress urinary incontinence (SUI) and pelvic organ prolapse. Vaginal mesh exposure and mesh erosion into the urinary tract is a complication seen with these surgeries. We reviewed our experience with lower urinary tract symptoms (LUTS) and dyspareunia outcomes following mesh explantation over a 7-year period in those patients who underwent surgery for mesh removal. METHODS A retrospective review of patients who underwent explantation of vaginal mesh from 2007 to 2013 was conducted. A total of 191 patients were identified of which 77 patients had evidence of vaginal mesh exposure and/or mesh erosion into the urinary tract. Other indications for mesh explantation included bladder outlet obstruction, pain, and dyspareunia. The following symptoms were evaluated at baseline and at 3 months follow-up: storage symptoms (frequency, urgency and nocturia=SS), voiding symptoms (hesitancy, straining, incomplete emptying and positional voiding=VS), dyspareunia, urge urinary incontinence (UUI), and SUI. RESULTS The most common presenting symptoms for the entire cohort were SS (76.6%) and VS (76.5%). Of the cohort, 53 patients had vaginal mesh exposure, 24 had erosion with 5 having both exposure and erosion. Patients presenting with vaginal mesh exposure did not differ in the array of presenting symptoms as compared with those patients with mesh erosion. The group of patients who had neither mesh exposure nor erosion had a significant improvement of all their symptoms at 3 months (p<0.03). Of the patients with vaginal mesh exposure, there was a statistical improvement in all of their symptoms, with the exception of SUI. The patients with mesh erosion had a significant improvement in VS (p<0.001) and dyspareunia (p=0.008), but no improvement in SS, UUI, or SUI. CONCLUSIONS This study demonstrates improvement in symptoms for those patients undergoing mesh removal surgery who do not have mesh exposure or erosion. However, for those patients with mesh erosion into the urinary tract there is comparatively less success in improving their urinary symptoms. This knowledge can be used in counseling patients with LUTS related to mesh complications prior to surgical mesh removal. No Mesh Exposure or Erosion (n=113) Mesh Exposure (n=53) Mesh Erosion (n=24) Presenting Symptoms: Storage 97 (85.8%) 40 (75.5%) 19 (79.2%) Voiding 78 (69.0%) 21 (39.6%) 11 (45.8%) Dyspareunia 41 (36.3%) 36 (67.9%) 14 (58.3%) UUI 66 (58.4%) 31 (58.5%) 14 (58.3%) SUI 49 (43.4%) 28 (52.8%) 12 (50.0%) 3 Months F/U: Storage 67 (59.3%) 24 (45.3%) 14 (58.3%) Voiding 29 (25.7%) 5 (9.4%) 5 (20.8%) Dyspareunia 12 (10.6%) 8 (15.1%) 6 (25.0%) UUI 45 (39.8%) 17 (32.1%) 15 (62.5%) SUI 49 (43.4%) 28 (52.8%) 12 (50.0%) © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e845 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Lara MacLachlan More articles by this author Justin Ellett More articles by this author Kelly Johnson More articles by this author Gini Ikwuezunma More articles by this author Michelle Koski More articles by this author Ross Rames More articles by this author Ahmed El-Zawahry More articles by this author Eric Rovner More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

OBJECTIVE To assess the penetration of media-based information on transvaginal mesh (TVM) in our patient population and to determine whether exposure affects patient opinion. Since the 2011 Federal Drug Administration communication on TVM, many advertisements from legal practices have been directed toward patients.MATERIALS AND METHODS An 18-item survey was administered to female patients at 2 sites from August 2012 to April 2013. Patients presenting with new diagnoses of pelvic organ prolapse or stress urinary incontinence or patients who reported prior mesh surgery were excluded.RESULTS Ninety-nine questionnaires were completed. Sixty-six of the patients (67%) were aware of TVM; and of these, 38 (58%) cited advertisements as the initial source of information. Only 12% were aware of the Food and Drug Administration's communication. Regarding opinion of TVM, 9% chose "it is a safe product," 9% "safety depends on factors related to patient," 4.5% "not a safe product," 1.5% "safety depends on the doctor," 68% "I don't know," and 4.5% marked 2 selections. Only 12% indicated knowing the difference in the use of TVM for pelvic organ prolapse vs stress urinary incontinence. When asked what influenced their opinion of TVM the most; responses were as follows: advertisement (33.3%), medical professional (22.7%), friends or family who underwent TVM procedure (12.1%), media article (6.1%), and "not sure" (25.8%).CONCLUSION Advertisements of TVM lawsuits had a high penetration into our patient population but did not produce an overtly negative response in our sample. Clinicians should be aware of the impact of these advertisements on patient opinion and counsel patients accordingly with unbiased and scientifically accurate information. (C) 2014 Elsevier Inc.

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Female Urology (I)1 Apr 20131573 OPERATE FOR PAIN, GET PAIN: IS IT TRUE FOR MESH? Kelly Johnson, Pramod Chopade, Gini Ikwuezunma, James Rosoff, Michelle Koski, Ross Rames, and Eric Rovner Kelly JohnsonKelly Johnson Charleston, SC More articles by this author , Pramod ChopadePramod Chopade Charleston, SC More articles by this author , Gini IkwuezunmaGini Ikwuezunma Charleston, SC More articles by this author , James RosoffJames Rosoff Charleston, SC More articles by this author , Michelle KoskiMichelle Koski Charleston, SC More articles by this author , Ross RamesRoss Rames Charleston, SC More articles by this author , and Eric RovnerEric Rovner Charleston, SC More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.3123AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES There has been increasing scrutiny of transvaginal mesh procedures due to related complications in some individuals, including the new onset of chronic pain postoperatively. Oftentimes, operating for the primary indication of pain in the genitourinary tract leads to poor results. We reviewed our database of transvaginal mesh interventions in order to assess whether preoperative pain can be subjectively improved. METHODS We present our 6 year experience of 134 patients requiring explantation of transvaginal mesh for a variety of indications including pain, bladder outlet obstruction, erosion, exposure, recurrent urinary tract infections and persistent lower urinary tract symptoms. We retrospectively analyzed initial presenting complaints and evaluated if patients experienced symptomatic improvement at both 3 and 12 months postoperatively. Our population requiring mesh explantation was divided into those who had slings versus prolapse mesh explanted. Chi-square and Fisher's exact tests were used to analyze the above variables. RESULTS 69 patients presented with a primary or secondary complaint of pain. In the sling incision group, 45% had pain at presentation, while only 23% and 19% had pain at 3 and 12 months follow up, respectively. In the prolapse mesh removal group, 68% had pain at presentation while only 24% and 19% had pain at 3 and 12 months postoperatively, respectively. Pain was the fourth most common presenting symptom in patients eventually requiring sling incision (after irritative symptoms, urge urinary incontinence and obstructive symptoms). Pain was the second most common presenting symptom in patients eventually requiring prolapse mesh removal (after irritative symptoms). The percentage of patients with pain steadily declined at 3 months and again at 12 months follow up. Statistical significance was reached regarding the resolution of pain in the transvaginal sling incision group (p=0.0025) and the prolapse mesh removal group (p=0.0008). CONCLUSIONS The majority of patients with pelvic pain following mesh explantation will have significant improvement or resolution of their pain postoperatively. However, almost 20% of patients will continue to suffer from bothersome pain 12 months following explantation. This knowledge is essential in counseling patients with pain related to mesh complications who are considering explantation of mesh. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e645-e646 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kelly Johnson Charleston, SC More articles by this author Pramod Chopade Charleston, SC More articles by this author Gini Ikwuezunma Charleston, SC More articles by this author James Rosoff Charleston, SC More articles by this author Michelle Koski Charleston, SC More articles by this author Ross Rames Charleston, SC More articles by this author Eric Rovner Charleston, SC More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Pelvic Prolapse1 Apr 20132150 PUBLIC PERCEPTION OF VAGINAL MESH AND THE MEDIA Jennifer Chamberlain, Taylor Vaughn, J.Christian Winters, Eric S. Rovner, Melissa R. Kaufman, and Michelle Koski Jennifer ChamberlainJennifer Chamberlain New Orleans, LA More articles by this author , Taylor VaughnTaylor Vaughn Charleston, SC More articles by this author , J.Christian WintersJ.Christian Winters New Orleans, LA More articles by this author , Eric S. RovnerEric S. Rovner Charleston, SC More articles by this author , Melissa R. KaufmanMelissa R. Kaufman Nashville, TN More articles by this author , and Michelle KoskiMichelle Koski Charleston, SC More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2059AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Since the 2011 FDA communication on transvaginal mesh (TVM), there has been a rapid increase in lawsuit advertisements in various media directly marketed to patients. We have encountered patients with heightened concerns citing these ads. Through a questionnaire-based study we hoped to assess the penetrance of ads into our patient population and to assess whether exposure to these ads affects patient opinion. METHODS A 17 item multiple choice survey was designed and beginning 8/2012, was given to female patients in urology and urogynecology clinics at two academic institutions after IRB approval. New patients with pelvic organ prolapse (POP) or stress incontinence (SUI) and patients who had undergone prior surgery at our institutions were excluded. We continue to accrue patients. RESULTS 78 questionnaires were completed. 53 (66.7%) of the patients had heard of TVM and of these, 33 (62%) cited such ads as the initial source of information. Regarding opinion of TVM, 1.9% chose “it is a safe product,” 7.5% “safety depends on factors related to patient,” 1.9% “not a safe product,” and 77.4% “I don't know.” 5.7% chose 2 selections and 3.8% patients chose “safety depends on the doctor”. Of those aware of TVM, 9 would consider mesh if they needed surgery for POP, 11 “no,” and 30 “maybe.” Of the “no” or “maybe” respondents- if a doctor told them they would benefit from mesh, 30.2% would change their mind, 9.4% would not, and 39.6% might. Only 11.3% indicated knowing the difference in use of TVM for POP vs. SUI. 15.1% were aware of the FDA safety communication. When asked what was the strongest influence on their opinion of TVM, responses were: advertisement, newspaper, or internet (32.1%), medical professional (26.4%), and “not sure” (28.3%). CONCLUSIONS Advertisements of TVM lawsuits have a high penetrance into our patient population. Few patients knew of the FDA communication or the difference in indication for TVM between POP and SUI. Despite this, patients indicated that they would still consider TVM, especially if advised by a physician. We must be aware of the effect of these ads on patient opinion and provide effective, unbiased, and scientifically accurate counseling of risks and benefits. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e880-e881 Peer Review Report Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jennifer Chamberlain New Orleans, LA More articles by this author Taylor Vaughn Charleston, SC More articles by this author J.Christian Winters New Orleans, LA More articles by this author Eric S. Rovner Charleston, SC More articles by this author Melissa R. Kaufman Nashville, TN More articles by this author Michelle Koski Charleston, SC More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Pelvic organ prolapse (POP) repair using native tissue has a significant risk of failure, especially for anterior compartment repair. Surgical techniques using a variety of mesh grafts and approaches have been developed to decrease the risk of recurrence and improve overall outcomes. Some, but not all, studies have demonstrated that synthetic mesh grafts and mesh kits improve objective outcomes. However, reports of complications with the use of synthetic mesh grafts and mesh kits have been emerging. Such reports have stirred the interests of physicians, medical societies, the media, and regulatory agencies such as the US Food and Drug Administration (FDA), which in July 2011 issued a Safety Communication updating a 2008 statement warning about synthetic mesh and mesh kit complications associated with POP repair. This article discusses current and future directions using synthetic mesh for anterior compartment POP repair in the context of the recent FDA communication.