Leng Boi Pue

Long-term outcome of native tissue reconstructive vaginal surgery for advanced pelvic organ prolapse at 86 months: Hysterectomy versus hysteropexy.

To evaluate and compare the long‐term outcome of sacrospinous ligament fixation (SSF) in combination with various other compartment defect native tissue repairs with hysterectomy or hysteropexy.

Assessment of collagen versus non collagen coated anterior vaginal mesh in pelvic reconstructive surgery: prospective study

OBJECTIVE To evaluate the sonologic and clinical outcome of collagen coated (CC) versus non-collagen coated (NC) anterior vaginal mesh (AVM) for pelvic organ prolapse (POP) surgery. STUDY DESIGN The study is a prospective observational study which included 122 patients who had symptomatic POP stage III and IV. AvaultaPlus™ (collagen coated, CC group) was compared to Perigee™ (non collagen coated, NC group). Introital ultrasound morphology, measure of neovascularization by color Doppler and clinical outcomes were assessed. Student t test was used for comparison of pre- and post-operation continuous data (p value of <0.05). RESULTS A total of 110 (CC group=50, NC group=60) women completed the study. A woman in the CC group developed ureteral injury. Both groups had comparable morphologic and clinical outcomes however, the onset of changes in mesh thickness and neovascularization occurred earlier in the NC group (1 month) compared to the CC group (6 months to 1 year). CONCLUSION CC group was comparable to the NC group in terms of erosion rate, ultrasound and clinical assessment. Collagen coating may induce delayed inflammatory response however may also delay tissue integration. The onset of changes in mesh thickness and neovascularization may give us an insight toward utilization of collagen coated mesh for host-tissue integration.

Delayed intravesical mesh erosion in a midurethral sling following further mesh-augmented pelvic prolapse surgery.

Intravesical mesh erosion and extrusion have been reported as devastating late complications of synthetic suburethral sling placement for the treatment of stress urinary incontinence. We report a case of a female patient with intravesical mesh erosion from a sling suspension that developed 4 years after primary prolapse surgery with mesh reinforcement. Intravesical mesh erosion was observed ultrasonographically and confirmed through cystoscopy. We excised the mesh via a vaginal approach and repaired both bladder mucosa and vaginal wall. As of this writing, the patient has been symptom‐free for the past year post‐surgery. Long‐term follow‐up is recommended in such cases. Anti‐incontinence surgery followed by primary prolapse surgery could potentially jeopardize the former. Complications may arise several years later so long‐term follow‐up is essential. Ultrasonography is an effective tool in evaluating mesh morphology and detecting intravesical mesh erosion.

Strangulated small bowel 14 years after abdominal sacrocolpopexy

Abdominal sacrocolpopexy is a well‐established procedure for the reconstruction of apical support in pelvic organ prolapse. Its long‐term efficacy is well known; however, it is also associated with higher perioperative morbidity when compared with the less invasive transvaginal approach. Long‐term risk of bowel‐related complication from abdominal sacrocolpopexy is rare, but can be significant as it is often serious and requires major surgical intervention. Here we highlight an unusual case of strangulated small bowel (in this instance complicated with sepsis secondary to peritonitis), 14 years after an abdominal sacrocolpopexy procedure. This example amplifies the need for proper preoperative counseling; also, life‐long follow‐up is necessary for patients undergoing this procedure.

Urethral Diverticulum in Young Nulliparous with Unusual Presentation

We highlight a case of chronic skenitis leading to the formation of Urethral diverticulum. A young nulliparous woman presented with dysuria, intermittent hematuria and a 3 cm cystic swelling adjacent to the left distal urethra. Aspiration of the cyst was done initially. Excisional biopsy was followed when it recurred. Urethral diverticulum was revealed when the excisional operation traced up to left distal urethral wall. The cystic swelling urethral diverticulum was completely enucleated.