Vaginal Mesh Removal Outcomes: Eight Years of Experience at an Academic Hospital
Vaginal Mesh Removal Outcomes: Eight Years of Experience at an Academic Hospital
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DOI：
10.1097/spv.0000000000000419
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发表时间：
2017-11-01
影响因子：
1.6
通讯作者：
Hatch, Kenneth D.
中科院分区：
文献类型：
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作者：
Cardenas-Trowers, Olivia O.;Malekzadeh, Pouran;Hatch, Kenneth D.
目的描述某学术医院行阴道补片摘除手术前的临床病史及术后转归。方法对2008-2015年间接受阴道补片摘除手术的患者进行回顾性分析。统计患者的人口学特征、临床病史、体格检查、手术前后症状、再次手术次数和类型。结果2008年2月至2015年11月，83例患者在本院接受了阴道网片摘除手术。首次置入网片至取出网片的中位时间为58个月(0.4~154个月)。最常见的术前症状是阴道疼痛(n=52，62%)、性交困难(n=46，55%)和盆腔疼痛(n=42，50%)。术中并发症较少(3例，4%)。术后4~6周内随访者中，尿失禁15例(28%)，阴道疼痛7例(13%)，臀部疼痛5例(9%)，尿路感染5例(9%)。没有可识别的危险因素来预测哪些患者会有持续性的术后症状，或者哪些患者需要进行超过1次的网眼摘除手术。阴道网片摘除后，29例(35%)患者需要1次或1次以上的再次手术，其中3例患者的再次手术次数最多。再手术总数为43次，共进行了63次个别手术。其中44%(n=28)为移植物切除，40%(n=25)为盆腔器官脱垂手术(仅为天然组织修复)，16%(n=10)为压力性尿失禁手术。49%(n=21)的患者再次手术次数超过1次。结论经阴道网片摘除手术是安全的，但部分患者需要1次以上手术，再次手术的危险因素尚不清楚。
Objectives The purpose of this study is to describe the clinical history leading up to and the outcomes after vaginal mesh removal surgery at an academic hospital.Methods A retrospective case series of patients who underwent vaginal mesh removal from 2008 to 2015 was conducted. Demographics, clinical history, physical examination, pre- and postoperative symptoms, and number and type of reoperations were abstracted.Results Between February 2008 and November 2015, 83 patients underwent vaginal mesh removal surgery at our hospital. The median time interval from initial mesh placement to removal was 58 months (range, 0.4-154 months). The most common preoperative symptoms were vaginal pain (n = 52, 62%), dyspareunia (n = 46, 55%), and pelvic pain (n = 42, 50%). Intraoperative complications were infrequent (n = 3, 4%). Of patients presenting for follow-up within 4 to 6 weeks postoperatively, the most common symptoms were urinary incontinence (n = 15, 28%), vaginal pain (n = 7, 13%), buttock pain (n = 5, 9%), and urinary tract infection (n = 5, 9%). There were no identifiable risk factors to predict which patients would have persistent postoperative symptoms or who would require more than 1 mesh removal surgery. After vaginal mesh removal, 29 patients (35%) required 1 or more reoperations, with 3 being the highest number of reoperations per patient. The total number of reoperations was 43, with a total of 63 individual procedures performed. Forty-four percent (n = 28) of the procedures were graft removals, 40% (n = 25) were pelvic organ prolapse surgeries (only native tissue repairs), and 16% (n = 10) were stress incontinence surgeries. More than 1 procedure was performed in 49% (n = 21) of the reoperations.Conclusions Vaginal mesh removal surgery is safe; however, some patients require more than 1 procedure, and the risk factors for reoperations are unclear.