RESUMO
INTRODUCTION AND HYPOTHESIS: We present a pure transvaginal approach to the removal of eroded mesh and a retained foreign body involving the bladder secondary to placement of transvaginal mesh for management of pelvic organ prolapse (POP) using a mesh kit. METHODS: Transvaginal excision of mesh erosion involving the bladder after mesh placement using a prolapse kit was performed. A U-shaped incision was made in the anterior vaginal wall; mesh was identified, divided in the midline, and then dissected from the bladder. Additionally, a retained foreign body was removed from the bladder. The bladder was closed in three layers transvaginally. RESULTS: Removal of eroded mesh and foreign body within the bladder was completed with all operative steps performed transvaginally. Follow-up cystogram was normal. There were no postoperative complications. CONCLUSIONS: Transvaginal removal of mesh erosion and retained foreign body involving the bladder is feasible and allows for rapid return to normal function.
Assuntos
Migração de Corpo Estranho/cirurgia , Procedimentos Cirúrgicos em Ginecologia/métodos , Slings Suburetrais/efeitos adversos , Telas Cirúrgicas/efeitos adversos , Doenças da Bexiga Urinária/etiologia , Fístula Vesicovaginal/etiologia , Idoso , Feminino , Humanos , Erros Médicos , Satisfação do Paciente , Polipropilenos/efeitos adversos , Tampões de Gaze Cirúrgicos/efeitos adversos , Doenças da Bexiga Urinária/cirurgia , Fístula Vesicovaginal/cirurgiaRESUMO
Achieving 100% closure and continence rate in the management of vesicovaginal fistulas remains a challenge. There is still debate about several aspects of the care including the following.
Assuntos
Tratamento Conservador/métodos , Procedimentos Cirúrgicos em Ginecologia/métodos , Cateterismo Urinário , Procedimentos Cirúrgicos Urológicos/métodos , Fístula Vesicovaginal/terapia , Transfusão de Componentes Sanguíneos , Transfusão de Sangue Autóloga , Cauterização , Feminino , Adesivo Tecidual de Fibrina/uso terapêutico , Humanos , Plasma Rico em Plaquetas , Complicações Pós-Operatórias/terapia , Transtornos Puerperais/terapia , Lesões por Radiação/terapia , Retalhos Cirúrgicos , Fatores de Tempo , Adesivos Teciduais/uso terapêutico , Cateteres Urinários , Incontinência Urinária por Estresse/prevenção & controleRESUMO
Uterine prolapse is one of the common reasons for hysterectomy throughout the world. However, recent data has shown that uterine-sparing techniques appear to be equivocal to that of hysterectomy. Older reports of intra-abdominal uterine suspension describe open approaches and more recent descriptions involve robotic and laparoscopic approaches utilizing mesh. We describe the first reported laparoendoscopic single-site (LESS) sacral hysteropexy utilizing a strip of polypropylene mesh placed posteriorly on the uterus and attached to the sacral promontory. A 45-year-old female with grade 3 uterine prolapse, cystocele, and rectocele underwent the procedure. The procedure involved access utilizing a single-port system placed transumbilically, and dissection using articulating laparoscopic instruments. The hysteropexy was completed by placing a 3-cm wide strip of polypropylene mesh along the posterior vaginal wall and cervicouterine junction, and suturing the proximal end to the anterior longitudinal ligament overlying the sacral promontory. The patient was discharged home within 18 h of the procedure. At 6 month follow-up, the patient has excellent anatomic support, with no evidence for recurrence of prolapse. LESS hysteropexy appears to be a safe, effective procedure for uterine prolapse and provides patients with excellent outcome with no visible scar. Additional studies will determine whether the LESS approach provides any benefit when compared with robotic or traditional laparoscopic approaches with respect to blood loss, pain, and time of full recovery.