From the Royal Women's, Mater and Wesley Urogynecology, Brisbane, Queensland, Australia.
Obstet Gynecol. 2010 Feb;115(2 Pt 1):325-330. doi: 10.1097/AOG.0b013e3181cbca4d.
While transvaginal polypropylene mesh is increasingly used in the management of pelvic organ prolapse, contraction of the mesh after implantation may cause substantial morbidity. This report defines the clinical entity of vaginal mesh contraction.
This is a case series of women who underwent surgical intervention for the management of symptomatic vaginal mesh contraction in our tertiary referral urogynecology center between January 2007 and December 2008. We evaluated the presenting symptoms, examination findings, subsequent management, and outcome.
Seventeen women with vaginal mesh contraction were included in this series. Clinical presentation included severe vaginal pain, aggravated by movement (17 of 17), dyspareunia in all sexually active women (14 of 14), and focal tenderness over contracted portions of the mesh on vaginal examination (17 of 17), commonly involving the lateral fixation arms. Mesh erosion (9 of 17), vaginal tightness (7 of 17), and shortening (5 of 17) were frequently present. Surgical intervention consisted of mobilization of the mesh from the underlying tissue, division of fixation arms from the central graft, and excision of contracted mesh. After surgery, 88% (15 of 17; 95% confidence interval 73-104) of women have experienced substantial reduction in vaginal pain and 64% (9 of 14; 95% confidence interval 39-89) experienced substantial reduction in dyspareunia. Three women required subsequent excision of the entire accessible mesh because of persisting symptoms.
Vaginal mesh contraction is a serious complication after prolapse repair with armed polypropylene mesh that is associated with substantial morbidity, frequently requiring surgical intervention. Research and development is urgently needed for newer graft materials with diminished shrinkage properties.
III.
尽管经阴道聚丙烯网片越来越多地用于治疗盆腔器官脱垂，但网片植入后的收缩可能会导致严重的发病率。本报告定义了阴道网片收缩的临床实体。
这是一个病例系列，研究对象是在我们的三级转诊泌尿妇科中心，于 2007 年 1 月至 2008 年 12 月期间因阴道网片收缩引起的症状而接受手术治疗的女性。我们评估了其临床表现、检查结果、后续治疗和结果。
本系列研究共纳入了 17 例阴道网片收缩的患者。临床表现包括严重的阴道疼痛，运动时加重（17/17），所有有性生活的女性均有性交困难（14/14），阴道检查时在网片收缩部位出现局灶性压痛（17/17），通常涉及外侧固定臂。网片侵蚀（9/17）、阴道紧绷（7/17）和缩短（5/17）较为常见。手术干预包括将网片从下方组织中游离出来，将固定臂从中央移植物上分离，以及切除收缩的网片。手术后，88%（15/17；95%置信区间 73-104）的患者阴道疼痛显著减轻，64%（9/14；95%置信区间 39-89）的患者性交困难显著减轻。由于持续存在症状，有 3 名女性需要进一步切除整个可触及的网片。
经阴道植入带刺聚丙烯网片修复脱垂后出现阴道网片收缩是一种严重的并发症，与严重的发病率相关，通常需要手术干预。迫切需要研究和开发具有较小收缩特性的新型移植物材料。
III。
