title: Mesh Perforation into a Viscus in the Setting of Pelvic Floor Surgery-Presentation and Management.
abstract: Perforation of a viscus with a mesh product either during or subsequent to pelvic floor reconstruction can be associated with devastating outcomes. If surgeons are going to place mesh, they also need to be familiar with symptoms concerning for perforation. The index of suspicion should always be present, as these patients can present years after initial mesh placement. The best opportunity for intervention in these serious complications is the first intervention. As bits of mesh are chipped away during attempted interventions, residual mesh fragments become disjointed, frayed, and scarred further, making their removal even more challenging, in addition to traumatizing likely already weakened tissues. This review presents strategies for patient evaluation in the setting of possible mesh perforation, in addition to treatment strategies for urethral, bladder, ureteral, and colonic/rectal injury. Ultimately, the decision as to how much mesh is removed should be based on each patient's unique presentation.
authors.affiliation: Division of Urology and Urologic Oncology, Department of Surgery, City of Hope, 412 W. Carroll Ave., Suite 200, Glendora, CA, 91741, USA. sethcohen@coh.org.
authors.forename: Seth A
authors.initials: SA
authors.lastname: Cohen
authors.affiliation: Glickman Urological and Kidney Institute, Cleveland Clinic, Lerner College of Medicine, 9500 Euclid Avenue, Mail Code Q10-1, Cleveland, OH, 44195, USA.
authors.forename: Howard B
authors.initials: HB
authors.lastname: Goldman
mesh_terms: D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D017773:Pelvic Floor / Q000601:surgery*; D012307:Risk Factors; D053825:Suburethral Slings / Q000009:adverse effects; D013526:Surgical Mesh / Q000009:adverse effects*; D014521:Urethra / Q000293:injuries* / Q000601:surgery; D001743:Urinary Bladder / Q000293:injuries* / Q000601:surgery
keywords: Holmium laser; Mesh complication; Midurethral sling; Pelvic pain; Urethral pain; Vaginal mesh