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Updated: Mar 17, 2026
Transvaginal Mesh Insertion in the Ovine Model
Published on: July 27, 2017
Mesh Perforation into a Viscus in the Setting of Pelvic Floor Surgery-Presentation and Management
Seth A Cohen1, Howard B Goldman2
1Division of Urology and Urologic Oncology, Department of Surgery, City of Hope, 412 W. Carroll Ave., Suite 200, Glendora, CA, 91741, USA. sethcohen@coh.org.
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.
Insights
Mesh perforation during or after pelvic floor reconstruction can cause severe complications. Surgeons must recognize symptoms and intervene early, as delayed treatment complicates mesh removal and tissue repair.
Area of Science:
- Urology
- Gynecology
- Gastroenterology
Background:
- Pelvic floor reconstruction with mesh can lead to viscus perforation.
- Perforation complications can be severe and manifest years after mesh placement.
- Early recognition and intervention are crucial for optimal outcomes.
Purpose of the Study:
- To review strategies for evaluating patients with suspected mesh perforation.
- To outline treatment approaches for various visceral injuries caused by mesh.
- To emphasize the importance of individualized treatment decisions regarding mesh removal.
Main Methods:
- Literature review of mesh-related visceral injuries.
- Analysis of diagnostic criteria for mesh perforation.
- Synthesis of treatment strategies for urethral, bladder, ureteral, and colonic/rectal injuries.
Main Results:
- Mesh perforation presents a significant risk in pelvic reconstructive surgery.
- Delayed diagnosis and intervention increase surgical complexity and tissue damage.
- Successful management requires a thorough understanding of potential injury patterns.
Conclusions:
- High index of suspicion is necessary for timely diagnosis of mesh perforation.
- Prompt surgical intervention offers the best chance for managing complications.
- The extent of mesh removal should be tailored to the individual patient's clinical presentation.
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