Cohen Seth A, Goldman Howard B
Division of Urology and Urologic Oncology, Department of Surgery, City of Hope, 412 W. Carroll Ave., Suite 200, Glendora, CA, 91741, USA.
Glickman Urological and Kidney Institute, Cleveland Clinic, Lerner College of Medicine, 9500 Euclid Avenue, Mail Code Q10-1, Cleveland, OH, 44195, USA.
Curr Urol Rep. 2016 Sep;17(9):64. doi: 10.1007/s11934-016-0621-3.
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.
在盆底重建过程中或之后，脏器被网状产品穿孔可能会导致灾难性后果。如果外科医生打算放置网状物，他们还需要熟悉与穿孔相关的症状。应始终保持怀疑指数，因为这些患者可能在最初放置网状物数年之后才出现症状。对这些严重并发症进行干预的最佳时机是首次干预。在尝试干预过程中，网状物碎片被一点点去除，残留的网状物碎片会变得脱节、磨损，并进一步形成瘢痕，这使得它们的移除更具挑战性，同时还会对可能已经很脆弱的组织造成创伤。本综述介绍了在可能发生网状物穿孔的情况下对患者进行评估的策略，以及针对尿道、膀胱、输尿管和结肠/直肠损伤的治疗策略。最终，关于移除多少网状物的决定应基于每个患者的独特表现。
