A robotic approach to management of failed sacrocolpopexy and sacrocolpopexy complications: a case series.

INTRODUCTION AND HYPOTHESIS: Approximately 5% of patients pursue reoperation after sacrocolpopexy (SCP). Reasons for re-operation include recurrence of prolapse, mesh erosion, bowel and bladder dysfunction, and pain. We aim to describe patient presentation, intraoperative findings, and subsequent robotic approach to management of SCP failures and complications. METHODS: This is a case series of patients who underwent abdominal re-exploration after SCP over 7 years at a single institution. Demographic data, previous prolapse surgery, presenting complaint, prolapse stage, operative notes, and outcomes were reviewed. Nineteen patients were identified by CPT codes; ten met inclusion criteria. RESULTS: Seven of the ten patients presented with vaginal bulge, urinary frequency and urgency; four also had stress urinary incontinence. Two patients presented with vaginal bleeding and another with vaginal pain. Operative findings on reoperation for patients who had vaginal bulge included detachment from the vagina or cervix (n = 4, 57%) and the anterior longitudinal ligament (n = 3, 43%). Of these, two had their SCP mesh reattached, and five had SCP mesh removal and replacement. The patients with vaginal bleeding and pain underwent mesh excisions. All ten patients had uncomplicated postoperative courses with resolution of symptoms in most cases. CONCLUSIONS: Prolapse recurrence and complications after SCP have a significant impact on patient quality of life. Recurrent prolapse after SCP theoretically occurs because of mesh detachment from the cervix/vagina, the anterior longitudinal ligament, or disruption/stretching of the mesh. Our case series demonstrates that abdominal re-exploration is feasible and valuable in these rare cases.

Rates of Pessary Self-Care and the Characteristics of Patients Who Perform it.

OBJECTIVE: The aims of this study were to determine the percentage of patients who opt to undergo pessary self-care versus those who return to the office for care and to identify any differences in the characteristics between the 2 groups. METHODS: This study is a retrospective chart review conducted at a tertiary care center. Demographic data; details regarding pessary use; body weight; pelvic organ prolapse stage; and medical, surgical, and obstetrical histories were evaluated. Variables were compared between groups of patients using the t test, Wilcoxon rank sum test, χ2 test, and Fisher exact test. RESULTS: The rate of patients choosing to perform pessary self-care was 31%. The patients in the self-care group were significantly younger (65.0 vs 75.0 years, P < 0.001). Those who were performing self-care were more likely to be premenopausal (6.9% vs 1.5%, P = 0.003), have a lower stage of pelvic organ prolapse (61.3% vs 42.1%, P < 0.001), and more likely to be sexually active (40.5% vs 9.6%, P < 0.001). Those not performing self-care had higher rates of vaginal bleeding (26.0% vs 16.4%, P = 0.012) and erosion (23.5% vs 9.9%, P < 0.001). Self-care patients predominantly used the ring with support pessary, whereas those in the non-self-care group were mostly using the Gellhorn. CONCLUSIONS: Only one third of patients who use a pessary chose to perform self-care. Patients who use self-care are younger, premenopausal, sexually active, and have lower degrees of prolapse. These data can help educate patients on the characteristics more often seen in those choosing self-care. This study highlights the importance of further exploring pessary care preferences and using this information for counseling.