Complications After Midurethral Sling Procedures Not Isolated, Research Shows

The vaginal mesh controversy appears to become more heated with the issuance by two medical groups associated with female pelvic medicine of a position statement. The use of vaginal mesh implants, particularly those used for midurethral sling procedures, according to the American Urogynecologic Society (AUGS) and Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction (SUFU), are safe for stress urinary incontinence (SUI) repairs. Even with this position taken by these organizations, results of various studies and statements from numerous pelvic surgeons that link this specific sling device to severe complications cannot be ignored.

Among the more common and severe complications linked to sling procedures using the midurethral sling devices are the following:

 

De Novo Urge Incontinence

 

A high incidence rate of de novo incontinence after a midurethral procedure, reported at 26 percent, has been experienced by patients according to results of several studies. When urge urinary incontinence appears after a sling procedure, the complication of de novo urgency is said to have occurred. Before it may be classified as a complication, this condition must not have been present before the sling procedure and it must persist six months after the surgery. Experiencing this adverse effect can be very tough for any woman who may have just wanted to rid of herself of SUI but instead ended up with another form of urinary incontinence.

 

Pelvic Organ Perforation

 

Organ perforation arises when pelvic organs are damaged after being punctured by parts of the mesh, particularly the rough edges. Experienced by seven to ten percent of all patients, bladder perforation may be considered the most common, although this complication may involve all pelvic organs.  The urethra may also be commonly affected and in a limited number, the bowels or the rectum. The complication, which may cause great pain and discomfort, has also been regarded as one of the most lethal especially when urine or feces gets into the bloodstream that may trigger life-threatening infections.

 

Hemorrhage and Vascular Injury

 

This complication may not be as common as the others, but this has been recognized as the most feared side effect since any injury to the blood vessels may result to death. Those that used the midurethral method reported the most number of complications among the different types of sling procedures. Blood loss of over 250 ml was experienced by five percent of patients who underwent this type of surgery, according to results of one study.

 

Mesh Erosion/Extrusion

 

The occurrence of mesh erosion, just like the repairs for pelvic organ prolapse (POP) and other types of sling procedures, is a common complication after using the midurethral method in the treatment of SUI. Mesh has been known to erode into the urethra and bladder causing the patient to experience symptoms such as pain during urination, dyspareunia or painful sexual intercourse, a feeling of burning sensation, and a host of urinary problems.

 

Severe symptoms such as intense pain, fever, infections, abscess, and even the deadly sepsis may be encountered when mesh erosion occurs in the bowel and colon. This complication has been noted by medical experts to possibly arise months or even years after the surgery and may have symptoms such as painful bowel movement, pain, constipation, and abdominal bloating.

 

References:

laborie.com

urology.ucsf.edu

medscape.org

 

meshsurgeons.com

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