Clinical outcomes of mesh exposure/extrusion: presentation, timing and management

Abstract

Background: The Food and Drug Administration has recently highlighted an increase in reported complications associated with the use of transvaginal mesh. Aims: To describe the clinical outcomes, presentation, timing and management of mesh exposure/extrusion Materials and Methods: Retrospective study from December 2006 to March 2012. A total of 40 women had vaginal mesh exposure/extrusion secondary to prior transvaginal mesh (TVM) surgery. Descriptive statistics were used for demographics and pre-operative data. Paired-samples t-test was applied for comparison of pre-and postoperation. A P value of <0.05 was considered statistically significant. Results: The mesh exposure/extrusion rate was noted to be 2.64% (17/642). Vaginal bleeding in 29 of 40 (72.5%) and hispareunia in 12 of 13 (92.3%) were identified as the most common symptoms for mesh exposure/extrusion. The onset of complications occurred in two peaks: between 3 and 4 months and after 1-year of follow-up. Initial conservative treatment was given for 12.5% (5/40) of women, while 87.5% (35/40) had undergone repair for mesh exposure/extrusion (21 outpatient and 14 inpatient cases). Among those who had conservative treatment, 80% (4/5) had persistent mesh exposure. Conclusion: Persistent or new-onset abnormal vaginal bleeding and hispareunia after TVM surgery should be considered as 'red flag' symptoms for mesh exposure/extrusion. Frequent follow-up from the first 3-4 months up to 1 year postoperative may identify complications. Utilisation of mesh excision or trimming as the initial means of treatment may yield a better outcome.

Techniques of transvaginal mesh prolapse surgery in Japan, and the comparison of complication rates by surgeons’ specialty and experience

“…[3][4][5][6] Although TVM decreased or was banned in Western countries after the 2011 FDA alert, 7,8 it remains as a core treatment option in East Asia due to fewer complications. [3][4][5][6]9,10 A questionnaire survey was carried out for surgeons who attended a national TVM meeting in 2010. Using the results of this survey, we investigated the practice patterns of prolapse surgery and TVM techniques at that time.…”

Foundation for an evidence‐informed algorithm for treating pelvic floor mesh complications: a review

“…Sexual dysfunction after MUS usually relates to new onset dyspareunia or partner complaints of discomfort during sexual relations (hispareunia) . Hispareunia, is generally due to mesh exposure and is resolved by successful partial excision of exposed mesh (grade B: limited evidence; moderate–high bias risk) . Dyspareunia associated with vaginal pain may be related to concurrent vaginal or groin pain, and may be successfully treated with complete excision of the vaginal portion of mesh (grade I: limited evidence; high bias risk) .…”

“…Sexual dysfunction following TVM for POP can relate to dyspareunia, hispareunia, and loss of vaginal tissue and volume due to contracture and scarring . Hispareunia usually relates to irritation from mesh exposure, best treated with trimming of exposed mesh and epithelial closure (grade I: limited evidence; moderate–high bias risk) . In the scenario of dyspareunia due to mesh contracture, removal of the vaginal wall portion of the mesh may be appropriate (grade I: limited evidence; moderate‐high bias risk) .…”

<p>Subjective and Objective Evaluation of Total Pelvic Floor Reconstruction with Six-Arm Mesh in Patients with Severe Pelvic Organ Prolapse: A 1-Year Retrospective Study</p>

“…However, in the past 10 years, the number of TVM procedures has not significantly decreased globally. 9 – 12 Although surgeons continue to improve surgical skills, they are also continuously improving the material of the mesh used and the implantation method to try to reduce the incidence of complications after TVM surgery. 13 TiLOOP ® Total six-mesh (pfm medical ag, Cologne, Germany) is made of a lighter titanium polypropylene mesh.…”