High Incidence of Vaginal Mesh Extrusion Using the Intravaginal Slingplasty Sling

Siegel, Andrew L.; Kim, Michelle; Goldstein, Martin; Levey, Samuel; Ilbeigi, Pedram

doi:10.1097/01.ju.0000173927.74235.e9

Cited by 49 publications

(37 citation statements)

References 14 publications

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“…A rabbit model comparing the IVS tape to four other graft materials concluded that the IVS tape had a similar tissue reaction at the beginning of transplantation, but had the weakest tissue attachment capacity [14]. A 17% incidence of mesh erosion has been reported using multifilament polypropylene tape in the midurethra (anterior IVS) for stress urinary incontinence [15].…”

Section: Discussionmentioning

confidence: 99%

Short-term efficacy and complications of posterior intravaginal slingplasty

et al. 2007

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This study was performed to evaluate the efficacy and complications of the posterior intravaginal slingplasty (IVS). A retrospective chart review was performed. Ninety IVS procedures were performed from January 2004 to June 2005. The group consisted of predominantly nonsmoking, Caucasian, postmenopausal women with a median age of 62 years and a median parity of 3. The mean follow-up was 33 +/- 23.2 weeks with a median of 31.9 weeks. There were no intraoperative bladder, bowel, or vascular injuries. Overall, 11 out of 90 patients developed recurrent or de novo prolapse; 4.4% of these had recurrent apical prolapse. There was a 17.8% incidence of mesh erosion. Only 1 of the 11 patients with recurrent prolapse had concomitant mesh erosion. The procedure demonstrated an unacceptably high erosion rate. The adoption of newer mesh techniques based on the slingplasty concept or the use of the multifilament polypropylene tape should be scrutinized.

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Section: Discussionmentioning

confidence: 99%

Short-term efficacy and complications of posterior intravaginal slingplasty

et al. 2007

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“…This might explain the development of IVS mesh extrusion with infection because bacteria might be able to infiltrate but cannot be eliminated by macrophages, which are too large to penetrate the pores and interstices [2]. Siegel et al [21] have reported that it showed a high rate of defective vaginal would healing and mesh extrusion, and it was not suitable as a sling material. However, in a randomized comparison study between 50 cases of TVT and 50 cases of IVS with a medial follow-up duration of 13.5 months, there were not any statistically significant differences in complication rates between the two groups [4].…”

Section: Discussionmentioning

confidence: 99%

A safety and quality of life analysis of intravaginal slingplasty in female stress incontinence: a prospective, open label, multicenter, and observational study

et al. 2007

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This prospective, open label, multicenter, and observational study was performed to determine the efficacy, safety, and the impact of this procedure on the current quality of life (QOL). One hundred three women underwent the intravaginal slingplasty (IVS) procedure. (74/83) cure rate. During follow-up period, one patient (1.2%) has presented with vaginal erosion of the sling material. The I-QOL showed significant improvement in total and three subscale scores at 12 months of follow-up period. This study demonstrated that the IVS procedure provides a safe and effective means for the treatment of female stress incontinence and improvement of QOL.

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“…Currently, the most commonly used synthetic material is loosely woven, polypropylene mesh. Major advantages include better dry rates, and avoidance of tissue harvesting [3] . In 1999, two authors first reported that the biomechanical properties of synthetic material are superior to those of autologous tissues [14] .…”

Section: Discussionmentioning

confidence: 99%

“…In our experience with vaginal mesh extrusion, re-epitheliazation usually does not completely cover the entirety of the mesh necessitating surgical removal. Vaginal extrusions are usually due to subclinical infections or disruption of the suture line by hematoma or trauma [3] . Thus, for those reasons, our practice is to perform immediate surgical excision in patients presenting with vaginal mesh extrusion.…”

Section: Discussionmentioning

confidence: 99%

“…Since then, various other autologous harvest sites have been identified, resulting in durable outcomes [2] . However, harvest site morbidities, including pain, difficulty with ambulation, cosmetic issues, and long recovery times, have led to the introduction of other materials [3] . Currently, synthetic materials have gained widespread acceptance for use in prolapse repair because of lack of harvest site morbidities, relative ease in placement, and the durability of the tension-free support that they provide [4,5] .…”

Section: Introductionmentioning

confidence: 99%

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The incidence of mesh extrusion after vaginal incontinence and pelvic floor prolapse surgery

Cohen

Kavaler

2014

JHA

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Purpose: The advantages of using synthetic mesh in vaginal reconstructive surgery are significant. However, the concern about extrusion has led many to question its use. We wished to learn the extrusion rates and time to extrusion in patients undergoing vaginal stress incontinence and prolapse surgeries using polypropylene mesh. Materials and methods:Five hundred and seventy six women underwent vaginal reconstructive surgery with synthetic mesh between August 2000 and October 2009 for the treatment of stress urinary incontinence, with or without pelvic organ prolapse repair. 367 patients had at least one year follow-up. Procedures were: pubo-vaginal sling (PVS), PVS and anterior repair, PVS with anterior and/or posterior repairs, and PVS with hysterectomy and anterior and posterior repairs. Time to mesh extrusion was estimated using a survival function curve.Results: Forty-two (11.4%) patients sustained a mesh extrusion. The rate of mesh extrusion was (6.3%) in the PVS group, (14.7%) in the PVS and anterior repair group, (11.1%) in the PVS with anterior and posterior repairs group and (5%) in the PVS with hysterectomy and anterior and posterior repair. Percent extrusion free at one to four years post-op was (91%) and (85%). Conclusion:Our study provides a large series of prolapse cases performed by a single surgeon with follow-up that extends at least one year, with the longest follow-up at eight years. The incidence of long term mesh extrusion needs to be considered with respect to the support advantages of synthetic mesh in planning vaginal reconstructive surgery.

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High Incidence of Vaginal Mesh Extrusion Using the Intravaginal Slingplasty Sling

Abstract: Our experience suggests that the IVS sling system, which uses a multi-filament polypropylene suburethral mesh, incurs an unacceptably high rate of defective vaginal wound healing and mesh extrusion.

Cited by 49 publications

References 14 publications

Short-term efficacy and complications of posterior intravaginal slingplasty

Short-term efficacy and complications of posterior intravaginal slingplasty

A safety and quality of life analysis of intravaginal slingplasty in female stress incontinence: a prospective, open label, multicenter, and observational study

The incidence of mesh extrusion after vaginal incontinence and pelvic floor prolapse surgery

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