Complications of synthetic mesh inserted for stress urinary incontinence

Abstract

Objective To provide an update on the literature regarding the management of complications secondary to synthetic mesh placed to treat stress urinary incontinence (SUI). Methods We performed a systematic review of the literature using a multi‐database structured search within OVID, the Medical Literature Analysis and Retrieval System Online (MEDLINE), the Excerpta Medica dataBASE (EMBASE) and Cochrane library databases; using the keywords: urology, incontinence, mesh and surgery. Results Several million synthetic polypropylene meshes have been inserted into women worldwide to manage SUI. Unfortunately, a significant number of women have now reported life‐changing complications. We found a paucity of studies, heterogeneity of cohorts, poor long‐term follow‐up, and lack of evidence on the effective management of mesh‐related complications. Conclusions The contemporary evidence is low‐level and often contradictory, which prevents robust recommendations regarding treatment. A prospective registry will be required to generate meaningful outcome data and help in the complex management of patients who have mesh‐related complications.

Wound dehiscence prevalence and relationship with prosthetic material extrusion in women underwent anterior colpotomy

“…In literature, prosthetic materials are associated to extrusion of the vaginal mucosa. 4,13,15,16,17 However, our findings showed that early wound dehiscence was correlated to synthetic materials; therefore, it is possible that some of the erosions/extrusions have begun as a not identified early asymptomatic wound dehiscence. An explanation of the pathophysiological mechanism is that synthetic materials may affect wound healing, impairing the balance of the vaginal epithelium favoring a dehiscence.…”

“…However, when prosthetic material is used, exposure is the most reported complication with a rate of up to 14% in MUS, and up to 17% in cystocele repair. 3 – 5 …”

“…However, when prosthetic material is used, exposure is the most reported complication with a rate of up to 14% in MUS, and up to 17% in cystocele repair. [3][4][5] Surgical wound dehiscence may affect any surgical procedure, and it is defined as the separation of opposed or sutured margins. [6][7][8][9] This complication usually occurs between 7 and 14 days after surgery.…”

Exploratory safety study of an umbilical cord derived urethral sling in bilateral pudendal nerves injury‐induced urinary incontinence in female rats

“…Although the clinical efficacy of MUS has long been demonstrated, recent warnings from scientific societies and regulatory agencies in various countries led to the recall of some mesh products used in pelvic organ prolapsus surgery 7 . Infection, chronic pain, and erosions are the main complications reported for MUS and are likely to be associated with the synthetic material used 8–10 …”

“…7 Infection, chronic pain, and erosions are the main complications reported for MUS and are likely to be associated with the synthetic material used. [8][9][10] In light of these findings, biological mesh materials have been proposed for SUI and pelvic prolapsus management to reduce these adverse events. 11 Biological materials, such as autologous fascial slings, have been proven efficient and safe in the management of SUI.…”