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Philippe E. Zimmern - One of the best experts on this subject based on the ideXlab platform.

  • Mesh Sling arm removal for persistent pain after an initial vaginal suburethral Mesh Sling removal procedure
    Female pelvic medicine & reconstructive surgery, 2020
    Co-Authors: Jorge Fuentes, Carlos Finsterbusch, Alana Christie, Philippe E. Zimmern
    Abstract:

    OBJECTIVES Pain is a recognized complication of mid-urethral Slings (MUS), which may lead to suburethral Sling removal (SSR) alone, or to a more extensive removal approach. We report on the outcomes of women who required an SSR or an additional secondary MUS arm removal for pain only. METHODS After Institutional Review Board (IRB) approval, the charts of nonneurogenic women who underwent SSR for pain only were reviewed. Demographic information, MUS type, self-reported pain resolution, and preoperative and postoperative questionnaires, including Urogenital Distress Inventory-Short form question 6 (UDI-6 Q6) scores, were collected for the SSR (group 1) and secondary removal (group 2) groups. RESULTS Of 52 women who underwent SSR for pain only between 2005 and 2018, 16 (31%) required a secondary procedure to remove the extension arms due to persistent pain after SSR. All women in group 2 experienced pain immediately after SSR (UDI-6 Q6 score of 2 to 3). Patients whose pain improved after SSR presented at a median 61 months after MUS whereas those in group 2 underwent SSR at median 34 months after MUS. Median duration of follow-up in group 2, after the secondary procedure, was 34 months. Over one half of those in group 2 (54%) noticed pain cure/improvement. Seven were left with persistent pain. CONCLUSIONS In women who underwent SSR for pain only, 67% reported pain resolution. An additional procedure to remove the extension arms of the Mesh was performed in one third of women for persistent pain after SSR.

  • mp30 09 secondary Mesh Sling arm removal for persistent pain after an initial vaginal sub urethral removal procedure for pain only
    The Journal of Urology, 2020
    Co-Authors: Jorge L Fuentes, Philippe E. Zimmern, Alana Christie, Carlos Finsterbusch
    Abstract:

    INTRODUCTION AND OBJECTIVE:Pain is a recognized complication of mid-urethral Slings (MUS) which may lead to sub-urethral Sling removal (SSR). A more extensive complete MUS removal upfront has been ...

  • is pain relief after vaginal Mesh and or Sling removal durable long term
    International Urogynecology Journal, 2018
    Co-Authors: Karen Jong, Alana Christie, Shreeya Popat, Philippe E. Zimmern
    Abstract:

    This study was to review our experience of pain relief durability in women who experienced initial pain resolution after vaginal Mesh and/or Sling removal (VMSR). A retrospective chart review of consecutive, nonneurogenic women who underwent VMSR for pain and reported persistent pain relief at the 6-month postoperative follow-up visit were assessed. Pre- and postoperative data collected were self-reported chief complaints, physical examination, other medical conditions associated with chronic pain, use of pain medications, Urogenital Distress Inventory-6 (in which question 6 specifically addresses pain), and the Numerical Pain Rating Scale (NPRS). Success was defined by continued resolution of pain assessed by score of 0 on NPRS (0 none to 10 terrible), (0–1 on the Urogenital Distress Inventory-6 (UDI-6) question 6, subjective report of pain-free status, and/or no chronic use of pain medications other than those prescribed for non-Mesh-related pain. Between 2006 and 2015, 125 of 356 women met study criteria. Mean follow-up after VMSR was 3.5 (range 0.5–10) years. Among 25 women who did not meet success criteria by questionnaire answers or subjective report, 21 had causes unrelated to their original Mesh/Sling placement and were pain free after they were addressed. Four women experienced delayed Mesh-related pain return at 28, 46, 47, and 54 months, respectively; two required Mesh removal surgery. Involvement in lawsuits and chronic pain-related medical conditions did not affect the durability of pain relief. At a mean follow-up of 3.5 years, the original pain relief noted after VMSR was durably maintained.

  • Bioerosion of Synthetic Sling Explants
    ACS Biomaterials Science & Engineering, 2017
    Co-Authors: Katherine E. Washington, Angela V Nguyen, Ruvanthi N. Kularatne, Majid Minary-jolandan, Philippe E. Zimmern, Gina Quiram, Mihaela C. Stefan
    Abstract:

    This study was performed to investigate the changes over time in polypropylene (PP) Mesh explants from women with stress urinary incontinence originally treated with a midurethral PP Sling. Following Institutional Review Board (IRB) approval, 10 PP explants removed for pain or obstructive symptoms between January and June 2016 were analyzed through various techniques to determine the degradation of the material in vivo. Exclusion criteria were exposed or infected Mesh Sling or Sling in place for less than six months. One pristine control was studied for comparison. The explant samples were analyzed with scanning electron microscopy to visualize the surface defects as well as infrared spectroscopy and energy dispersive X-ray spectroscopy to determine if the degradation was oxidative in nature. The results show qualitative and quantitative bioerosion over the surface of the explant samples and an increase in the content of oxygen pointing toward oxidative degradation occurring in vivo.

  • Mesh Sling in an era of uncertainty lessons learned and the way forward
    European Urology, 2013
    Co-Authors: Christopher R Chapple, Shlomo Raz, Linda Brubaker, Philippe E. Zimmern
    Abstract:

    Following transvaginal Mesh, synthetic Slings to correct stress urinary incontinence have been put under further scrutiny. Since the recent FDA website update, we reviewed the latest developments and then reflected on the lessons learned by applying this process and the way forward.

Jerry G Blaivas - One of the best experts on this subject based on the ideXlab platform.

  • mp20 05 Mesh Sling complications feasibility of accessing data from patients involved in Mesh litigation
    The Journal of Urology, 2019
    Co-Authors: Jerry G Blaivas, Bilal Chughtai, Senad Kalkan, Linda Dayan, Learta Prishtina, Joel Mathew
    Abstract:

    INTRODUCTION AND OBJECTIVES:Controversy exists about the safety of synthetic Mesh Slings (SMUS). The aim of this feasibility study is to avail ourselves of a potential cohort derived from approxima...

  • salvage surgery after failed treatment of synthetic Mesh Sling complications
    The Journal of Urology, 2013
    Co-Authors: Jerry G Blaivas, Rajveer S Purohit, James M Weinberger, Johnson F Tsui, Jyoti Chouhan, Ruhee Sidhu, Kamron Saleem
    Abstract:

    Purpose: We report our experience with the diagnosis and treatment of refractory synthetic Sling complications in women.Materials and Methods: This is a retrospective study of consecutive women with failed treatments for Mesh Sling complications. Before and after surgery the patients completed validated questionnaires and voiding diaries, and underwent uroflow with post-void residuals, pad test, cystourethroscopy and videourodynamic studies. Treatment was individualized, and results were subdivided into the 2 groups of conditions and symptoms. Outcomes were assessed with the Patient Global Impression of Improvement with success classified as a score of 1, improvement as 2 to 3 and failure as 4 to 7.Results: A total of 47 women 35 to 83 years old (mean 60) had undergone at least 1 prior operation (range 1 to 4) to correct Sling complications. Original Sling composition was type 1 Mesh in 36 patients and types 2 and 3 in 11. Surgical procedures included Sling incision, Sling excision, urethrolysis, urethral...

Ipek Gurolurganci - One of the best experts on this subject based on the ideXlab platform.

  • impact of a mid urethral synthetic Mesh Sling on long term risk of systemic conditions in women with stress urinary incontinence a national cohort study
    British Journal of Obstetrics and Gynaecology, 2021
    Co-Authors: Ipek Gurolurganci, Patrick Muller, Ranee Thakar, J Van Der Meulen, Swati Jha
    Abstract:

    OBJECTIVE: To compare the incidence of systemic conditions between women who had surgical treatment for stress incontinence with Mesh and without Mesh. DESIGN: National cohort study. SETTING: English National Health Service. POPULATION: Women with no previous record of systemic disease who had first-time urinary incontinence surgery between 1 January 2006 and 31 December 2013, followed up to the earliest of 10 years or 31 March 2019. METHODS: Competing-risks regression was used to estimate hazard ratios (HR), adjusted for patient characteristics, with HR > 1 indicating increased incidence following Mesh surgery. MAIN OUTCOME MEASURES: First post-operative admission with a record of autoimmune disease, fibromyalgia or myalgic encephalomyelitis up to 10 years following the first incontinence procedure. Competing-risks regression was used to estimate hazard ratios (HR) of admission, adjusted for patient characteristics, with HR > 1 indicating increased incidence following Mesh surgery. RESULTS: The cohort included 88 947 women who had Mesh surgery and 3 389 women who had non-Mesh surgery. Both treatment groups were similar with respect to age, socio-economic deprivation, comorbidity, and ethnicity. The 10-year cumulative incidence of autoimmune disease, fibromyalgia or myalgic encephalomyelitis was 8.1% (95% confidence interval 7.9% to 8.3%) in the Mesh group and 9.0% (8.0% to 10.1%) in the non-Mesh group (adjusted HR 0.89 [0.79 to 1.01]; p = 0.07). A sensitivity analysis including only autoimmune diseases as an outcome returned a similar result. CONCLUSIONS: These findings do not support claims that synthetic Mesh Slings cause systemic disease.

  • long term rate of Mesh Sling removal following midurethral Mesh Sling insertion among women with stress urinary incontinence
    JAMA, 2018
    Co-Authors: Ipek Gurolurganci, Rebecca S Geary, Jil Mamza, Jonathan Duckett, Dina Elhamamsy, Lucia Dolan, Douglas G Tincello
    Abstract:

    Importance There is concern about outcomes of midurethral Mesh Sling insertion for women with stress urinary incontinence. However, there is little evidence on long-term outcomes. Objective To examine long-term Mesh removal and reoperation rates in women who had a midurethral Mesh Sling insertion for stress urinary incontinence. Design, Setting, and Participants This population-based retrospective cohort study included 95 057 women aged 18 years or older who had a first-ever midurethral Mesh Sling insertion for stress urinary incontinence in the National Health Service hospitals in England between April 1, 2006, and December 31, 2015. Women were followed up until April 1, 2016. Exposures Patient and hospital factors and retropubic or transobturator Mesh Sling insertions. Main Outcomes and Measures The primary outcome was the risk of midurethral Mesh Sling removal (partial or total) and secondary outcomes were reoperation for stress urinary incontinence and any reoperation including Mesh removal, calculated with death as competing risk. A multivariable Fine-Gray model was used to calculate subdistribution hazard ratios as estimates of relative risk. Results The study population consisted of 95 057 women (median age, 51 years; interquartile range, 44-61 years) with first midurethral Mesh Sling insertion, including 60 194 with retropubic insertion and 34 863 with transobturator insertion. The median follow-up time was 5.5 years (interquartile range, 3.2-7.5 years). The rate of midurethral Mesh Sling removal was 1.4% (95% CI, 1.3%-1.4%) at 1 year, 2.7% (95% CI, 2.6%-2.8%) at 5 years, and 3.3% (95% CI, 3.2%-3.4%) at 9 years. Risk of removal declined with age. The 9-year removal risk after transobturator insertion (2.7% [95% CI, 2.4%-2.9%]) was lower than the risk after retropubic insertion (3.6% [95% CI, 3.5%-3.8%]; subdistribution hazard ratio, 0.72 [95% CI, 0.62-0.84]). The rate of reoperation for stress urinary incontinence was 1.3% (95% CI, 1.3%-1.4%) at 1 year, 3.5% (95% CI, 3.4%-3.6%) at 5 years, and 4.5% (95% CI, 4.3%-4.7%) at 9 years. The rate of any reoperation, including Mesh removal, was 2.6% (95% CI, 2.5%-2.7%) at 1 year, 5.5% (95% CI, 5.4%-5.7%) at 5 years, and 6.9% (95% CI, 6.7%-7.1%) at 9 years. Conclusions and Relevance Among women undergoing midurethral Mesh Sling insertion, the rate of Mesh Sling removal at 9 years was estimated as 3.3%. These findings may guide women and their surgeons when making decisions about surgical treatment of stress urinary incontinence.

  • long term rate of Mesh Sling removal following midurethral Mesh Sling insertion among women with stress urinary incontinence
    JAMA, 2018
    Co-Authors: Ipek Gurolurganci, Rebecca S Geary, Jil Mamza, Jonathan Duckett, Dina Elhamamsy, Lucia Dolan, Douglas G Tincello
    Abstract:

    Importance There is concern about outcomes of midurethral Mesh Sling insertion for women with stress urinary incontinence. However, there is little evidence on long-term outcomes. Objective To examine long-term Mesh removal and reoperation rates in women who had a midurethral Mesh Sling insertion for stress urinary incontinence. Design, Setting, and Participants This population-based retrospective cohort study included 95 057 women aged 18 years or older who had a first-ever midurethral Mesh Sling insertion for stress urinary incontinence in the National Health Service hospitals in England between April 1, 2006, and December 31, 2015. Women were followed up until April 1, 2016. Exposures Patient and hospital factors and retropubic or transobturator Mesh Sling insertions. Main Outcomes and Measures The primary outcome was the risk of midurethral Mesh Sling removal (partial or total) and secondary outcomes were reoperation for stress urinary incontinence and any reoperation including Mesh removal, calculated with death as competing risk. A multivariable Fine-Gray model was used to calculate subdistribution hazard ratios as estimates of relative risk. Results The study population consisted of 95 057 women (median age, 51 years; interquartile range, 44-61 years) with first midurethral Mesh Sling insertion, including 60 194 with retropubic insertion and 34 863 with transobturator insertion. The median follow-up time was 5.5 years (interquartile range, 3.2-7.5 years). The rate of midurethral Mesh Sling removal was 1.4% (95% CI, 1.3%-1.4%) at 1 year, 2.7% (95% CI, 2.6%-2.8%) at 5 years, and 3.3% (95% CI, 3.2%-3.4%) at 9 years. Risk of removal declined with age. The 9-year removal risk after transobturator insertion (2.7% [95% CI, 2.4%-2.9%]) was lower than the risk after retropubic insertion (3.6% [95% CI, 3.5%-3.8%]; subdistribution hazard ratio, 0.72 [95% CI, 0.62-0.84]). The rate of reoperation for stress urinary incontinence was 1.3% (95% CI, 1.3%-1.4%) at 1 year, 3.5% (95% CI, 3.4%-3.6%) at 5 years, and 4.5% (95% CI, 4.3%-4.7%) at 9 years. The rate of any reoperation, including Mesh removal, was 2.6% (95% CI, 2.5%-2.7%) at 1 year, 5.5% (95% CI, 5.4%-5.7%) at 5 years, and 6.9% (95% CI, 6.7%-7.1%) at 9 years. Conclusions and Relevance Among women undergoing midurethral Mesh Sling insertion, the rate of Mesh Sling removal at 9 years was estimated as 3.3%. These findings may guide women and their surgeons when making decisions about surgical treatment of stress urinary incontinence.

Kamron Saleem - One of the best experts on this subject based on the ideXlab platform.

  • salvage surgery after failed treatment of synthetic Mesh Sling complications
    The Journal of Urology, 2013
    Co-Authors: Jerry G Blaivas, Rajveer S Purohit, James M Weinberger, Johnson F Tsui, Jyoti Chouhan, Ruhee Sidhu, Kamron Saleem
    Abstract:

    Purpose: We report our experience with the diagnosis and treatment of refractory synthetic Sling complications in women.Materials and Methods: This is a retrospective study of consecutive women with failed treatments for Mesh Sling complications. Before and after surgery the patients completed validated questionnaires and voiding diaries, and underwent uroflow with post-void residuals, pad test, cystourethroscopy and videourodynamic studies. Treatment was individualized, and results were subdivided into the 2 groups of conditions and symptoms. Outcomes were assessed with the Patient Global Impression of Improvement with success classified as a score of 1, improvement as 2 to 3 and failure as 4 to 7.Results: A total of 47 women 35 to 83 years old (mean 60) had undergone at least 1 prior operation (range 1 to 4) to correct Sling complications. Original Sling composition was type 1 Mesh in 36 patients and types 2 and 3 in 11. Surgical procedures included Sling incision, Sling excision, urethrolysis, urethral...

Bassem S Wadie - One of the best experts on this subject based on the ideXlab platform.

  • endoscopic excision of an eroding calcified Mesh Sling 10 years after primary surgery
    International Urogynecology Journal, 2009
    Co-Authors: Bassem S Wadie
    Abstract:

    Management of urethral erosion typically entails two options: Sling incision (in the early postoperative period) or excision of the suburethral part of the Sling (urethrolysis). This paper describes a different endoscopic technique. A forty-year-old woman with a synthetic Sling implanted 10 years prior presented with persistent lower urinary tract symptoms. A kidney ureter bladder X-ray showed a stone at the level of the bladder neck. Disintegration of the stone revealed eroding Mesh embedded in the urethral wall. Complete resection of the Mesh using an electrocautery knife was performed. Two months since the procedure, the patient has had an uneventful course. Both vaginal and urethral walls are intact, and she is capable of normal voiding with some stress incontinence. Although it is unusual, a Sling eroding the urethra is a diagnosis that needs to be considered even 10 years after surgery. Endoscopic management is feasible and can be successful.