Costantini Elisabetta, Zucchi Alessandro, Lazzeri Massimo, Del Zingaro Michele, Vianello Alberto, Porena Massimo
Department of Medical-Surgical Specialties and Public Health, Section of Urology and Andrology, University of Perugia, Perugia, Italy. ecostant @ unipg.it
Urol Int. 2011;86(4):419-23. doi: 10.1159/000324243. Epub 2011 Mar 30.
To report conservative and surgical strategies for treatment of mesh erosion after pelvic organ prolapse (POP) repair.
Between 1998 and 2008, 179 patients underwent integral pelvic floor reconstruction for advanced POP in our tertiary urogynecological unit. Patients' charts and follow-up data were entered into a computerized database and data analysis performed to search for mesh erosion/complications/surgery.
12 patients were diagnosed and treated for mesh erosion: in 10 of 179, surgery was performed in our department and the mesh used was polypropylene (PP): 3 after colposacropexy (CSP) (5.5%), 5 after CSP + hysterectomy (Hys) (6.5%), and 2 after hysterosacropexy (HSP) (3.9%); in 1 case, Gore-tex mesh was used, and another case had undergone CSP in another hospital using PP mesh. Time to mesh erosion ranged from 2 to 66 months (mean 22.9), with 4 erosions (33%) within 6 months of POP repair. In 4 asymptomatic patients (33%) erosion was incidentally discovered during clinical check-ups at 4, 31, 36 and 66 months. Five cases (41%) presented with occasional vaginal bleeding, associated with dyspareunia in 2. Treatments were individualized but in all cases conservative treatment was unable to resolve the complications and surgery was needed. At a mean follow-up of 57 months (range 18-120) after surgical treatment all patients were asymptomatic and free from erosions.
The surgeon who approaches management of complications after abdominal/laparoscopic sacropexy should possess a comprehensive understanding of pelvic floor anatomy and surgical skills in order to individualize the management of such complications.
报告盆腔器官脱垂（POP）修复术后网片侵蚀的保守和手术治疗策略。
1998年至2008年期间，179例患者在我们的三级泌尿妇科单位接受了晚期POP的整体盆底重建术。将患者病历和随访数据录入计算机数据库，并进行数据分析以查找网片侵蚀/并发症/手术情况。
12例患者被诊断并接受了网片侵蚀治疗：在179例中的10例中，在我们科室进行了手术，使用的网片为聚丙烯（PP）：3例在阴道骶骨固定术（CSP）后（5.5%），5例在CSP+子宫切除术（Hys）后（6.5%），2例在子宫骶骨固定术（HSP）后（3.9%）；1例使用了戈尔特斯网片，另1例在另一家医院接受了使用PP网片的CSP。网片侵蚀出现的时间为2至66个月（平均22.9个月），4例侵蚀（33%）发生在POP修复术后6个月内。4例无症状患者（33%）在4、31、36和66个月的临床检查中偶然发现侵蚀。5例（41%）出现偶尔的阴道出血，其中2例伴有性交困难。治疗是个体化的，但在所有病例中，保守治疗无法解决并发症，需要进行手术。手术治疗后平均随访57个月（范围18 - 120个月），所有患者均无症状且无侵蚀。
处理腹部/腹腔镜骶骨固定术后并发症的外科医生应全面了解盆底解剖结构和手术技巧，以便对此类并发症进行个体化管理。
