Classification System

Complications of vaginal supportive implants for prolapse surgery. New complications, new symptomatology, prevention and treatment

  • MICHEL COSSON
  • PIERRE COLLINET
  • MALEK BOUKERROU
  • JEAN PHILIPPE LUCOT
  • PHILIPPE DEBODINANCE
  • BERNARD JACQUETIN

Pelviperineology 2009;28(1):10-13

We describe a simple description of complications related to synthetic implants used in the treatment of stress incontinence or prolapse by the vaginal route. We describe their symptoms and propose a strategy for prevention and treatment of these complications. We will describe successively: Type 1: defect of vaginal healing - 1A: exposure of vaginal implant. 1B: abnormal healing: polyps, synechiae. Type 2: infection of the implant - 2A: persistent vaginal exposure with apparent local infection; 2B: infection along the implant; 2C: skin erosion near issue of the prosthesis, contiguous infection and fistulae along the supportive implant; 2D: contact abscess; 2E: distant abscess; 2F: fistulae; 2G: acute infection: pelvic cellulitis. Type 3: contraction of implant - Grade 1: palpation of supportive implant is painless, retraction moderate and asymptomatic, arm or body of the prosthesis is palpable but not thickened. Grade 2: retraction is moderate (less than about 30%) and\or without many symptoms, palpation may be sensitive, prosthesis globally moderately thickened without nodulae. Grade 3: important contraction (more than 50%) and\or painful palpation with localized thickening of the implant. 3A - important contraction, moderate symptomatology. 3B - important and symptomatic contraction. Grade 4: simple contact of implant is painful ++ even if contraction is not always palpable. Type 4: erosions due to implant a) erosions of vaginal fornix; b) uretral erosion; c) bladder erosion; d) rectal erosions; e) other distant erosions. This classification can only be temporary but distinguishes different types of complications too often mixed up in publications.