Javier Casado

Background/Objectives: Mesh-related complications after surgery for stress urinary incontinence (SUI) and pelvic organ prolapse (POP) remain a clinical challenge, and surgical revision is often required. However, its impact on functional outcomes and continence status is incompletely defined. This study aimed to evaluate voiding and continence outcomes after surgical revision of vaginal synthetic mesh. Methods: This retrospective multicenter study included 55 consecutive women undergoing surgical revision of synthetic mesh for symptomatic complications after SUI or POP procedures between March 2021 and April 2025. Preoperative evaluation included clinical assessment, uroflowmetry, and selective imaging or urodynamic studies. Surgical management included mesh section, partial removal, or total removal via vaginal, abdominal, or combined approaches. The primary outcome was change in Qmax and post-void residual (PVR). Secondary outcomes included symptom resolution, changes in urgency urinary incontinence (UUI) and SUI, and postoperative complications. Results: Obstructive voiding dysfunction was the leading indication for revision (47.3%). Median Qmax increased from 13.0 to 18.0 mL/s (p = 0.0013), and median PVR decreased from 55.0 to 5.0 mL (p < 0.001). UUI improved from 56.4% to 34.5% (p = 0.017, McNemar’s exact test). Conversely, SUI increased from 20.0% to 56.4% (p < 0.001), although only 16 patients (29.1%) had clinically significant postoperative SUI, of whom 7 underwent a secondary anti-incontinence procedure. Intraoperative complications were infrequent (5.5%), while postoperative urinary tract infections occurred in 16.4%. Conclusions: Mesh revision surgery improves voiding function and reduces storage symptoms in selected patients but carries a substantial risk of recurrent or de novo SUI, underscoring the need for careful patient selection and counseling, with an acceptable safety profile in experienced centers.

Purpose Pudendal nerve entrapment (PNE) diagnosis is not standardized. This leads to diagnosis delays, impacting quality of life and therapeutic outcomes. The main goal is to find the role of neurophysiological study (NFS) and Imaging-guided pudendal nerve infiltration (ImPNI) in PNE diagnosis and patient selection for surgery. Methods A retrospective, multicentric study was conducted. Patients with PNE refractory to conservative treatment were included. Patient data, including NFS results, ImPNI, and surgical outcomes, were evaluated. A visual analogue scale was used to assess intervention response. Test performance metrics for NFS and ImPNI and binary logistic regression were used to determine their predictive value for postoperative improvement. Results 88 patients were diagnosed with PNE. All had NFS, and ImPNI was performed in 69 (78.4%), with 60 (68.2%) showing symptom improvement. Among the 40 patients (85%) who underwent pudendal nerve decompression surgery, 75% improved after surgery, and 20% did not. The combination of NFS and ImPNI showed a sensitivity of 79% and a specificity of 85.7%, with a Positive Predictive Value (PPV) of 98% and a Negative Predictive Value (NPV) of 30%. NFS and ImPNI were significant predictors of surgical success with p-values of 0.013 [ 95% CI: -23.6—19.9] and 0.003 [95% CI: -20.6 -18.5], respectively. Primary limitations: retrospective design and the absence of a control group. Conclusions NFS and ImPNI are essential and highly reliable tools for diagnosing PNE. ImPNI is a valuable predictor of surgical outcomes. These findings enable precise patient selection for surgery, ensuring optimal surgical outcomes.

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