Histopathology of excised midurethral sling mesh

Hill, Audra Jolyn; Unger, Cécile A.; Solomon, Ellen; Brainard, Jennifer; Barber, Matthew D.

doi:10.1007/s00192-014-2553-0

Cited by 8 publications

(7 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Consistent with prior studies in the literature examining pathology findings of explanted mesh, 9,10,15,19 we predominantly noted fibrosis (98%), chronic inflammation (54%), and foreign-body giant cell reaction (66%). The elevated percentage of fibrosis may be explained by the fact that it is part of the normal reaction to a mesh material, and over time, fibrotic encapsulation is the expected response to a foreign body.…”

Section: Discussionsupporting

confidence: 89%

No Correlation Between Presenting Symptoms Prior to Suburethral Sling Removal and Explanted Pathology Findings Suggests No Need for Routine Microscopic Pathology Evaluation

Patel¹,

Christie

2021

Female Pelvic Med Reconstr Surg

View full text Add to dashboard Cite

Objectives: We compared explanted midurethral sling (MUS) standard clinical pathology report findings with presenting symptoms before synthetic sling removal (SSR).Methods: An institutional review board-approved, prospectively maintained database of women who underwent a single SSR for MUS-related complication(s) was retrospectively reviewed for demographics, time interval between MUS placement and SSR, MUS type, and presenting symptoms before SSR. We compared 2 groups, one with MUS-related symptoms, including incontinence, voiding dysfunction, dyspareunia/pain, erosion, exposure, and/or urinary tract infections, and the second group characterized by self-reported symptoms attributed to the mesh material (systemic, autoimmune, or inflammatory disorder-mesh reaction group).Results: From 2005 to 2019, 332 of 473 women met study criteria, with 24 reporting mesh reaction-related symptoms. There was no difference in microscopic pathology findings between the 2 groups. In the mesh-related group, women were younger (P = 0.041) and had more pain/dyspareunia as their primary SSR indication (P = 0.002). That group was also significantly more likely to have a preexisting diagnosis of fibromyalgia (P < 0.001) and established autoimmune disorder (P = 0.033). No significant correlation between presenting findings and sling pathology was observed. Conclusions:No correlation was observed when comparing pathological findings of explanted MUS with presenting symptoms of MUS-related complications, including in women with mesh reaction-related concerns.

show abstract

Section: Discussionsupporting

confidence: 89%

No Correlation Between Presenting Symptoms Prior to Suburethral Sling Removal and Explanted Pathology Findings Suggests No Need for Routine Microscopic Pathology Evaluation

Patel¹,

Christie

2021

Female Pelvic Med Reconstr Surg

View full text Add to dashboard Cite

show abstract

“…However, it is important to note that 35% of women in this cohort experienced pain in the absence of mesh exposure or erosion. This may be explained by the histopathologic findings and inflammatory response that have been observed with the use of transvaginal polypropylene mesh, which may invoke pain without clinical evidence of obstruction or erosion [30][31][32]. Prior studies have shown that 60% to 80% of women have relief of pain after mesh removal (TVM and/or sling mesh) [15,22], and our results are consistent with these reports.…”

Section: Characteristics Of Women Undergoing Mesh Removalsupporting

confidence: 90%

Tobacco use, immunosuppressive, chronic pain, and psychiatric conditions are prevalent in women with symptomatic mesh complications undergoing mesh removal surgery

et al. 2020

View full text Add to dashboard Cite

To identify demographic and clinical characteristics of patients with symptomatic pelvic floor mesh complications who underwent mesh removal at our academic medical center. The secondary goal was to determine patient-reported outcomes after mesh removal. Materials and Methods: We conducted a retrospective review of consecutive patients from 2011-2016 undergoing removal of mesh graft for treatment of symptomatic mesh-related complications. Patient demographics, comorbidities, symptoms, and mesh factors were evaluated. Outcomes after explant were determined by the Patient Global Impression of Improvement and a Likert satisfaction scale. Results: One hundred fifty-six symptomatic patients underwent complete or partial pelvic floor mesh removal during the study period. Mid-urethral slings comprised 86% of explanted mesh grafts. Mesh exposure or erosion was identified in 72% of patients. Eighty-one percent of patients presented with pain, and 35% reported pain in the absence of exposure or erosion. Pre-operative comorbidities included psychiatric disease (54.5%), chronic pain (34.0%), irritable bowel syndrome (20.5%) and fibromyalgia (9.6%). Forty-three percent of patients reported current or past tobacco use. At mean follow-up of 14 months, 68% of responding patients reported improvement on the Patient Global Impression of Improvement after surgery. Conclusions: This research identified tobacco use, and psychiatric, immunosuppressive, and chronic pain conditions as prevalent in this cohort of patients undergoing mesh removal. Surgical removal can improve presenting symptoms, including for patients with pain in the absence of other indications.

show abstract

“…Histological study of human tissue from patients having undergone revision, removal or planned biopsy following transvaginal mesh or midurethral sling demonstrated a mild persistent inflammatory reaction to polypropylene [67,[140][141][142][143][144]. This effect has been seen in prospective vaginal punch biopsies showing increased macrophages and mast cell infiltration 2 years after transvaginal mesh placement [140].…”

Section: Histologymentioning

confidence: 91%

“…Review of pathology reports from explanted vaginal mesh specimens included the diagnostic terminology 'fibrous/fibrosis' in 70.1% of explants, 'foreign body giant cell reaction' in 18.8% and 'inflammation' in 10.4% [143]. When midurethral sling explants were examined, inflammation was significantly higher in patients with only voiding dysfunction as opposed to those with mesh exposure or a mixed presentation [142]. The observation that there are different tissue reactions based on presentation is further supported by the work of Nolfi et al When examining polypropylene vaginal explants removed after 4.5-93 months, patient-reported pain was associated with profibrotic interleukin-10 and M2 'proremodelling' macrophages, while those presenting with erosion had an increase in proteolytic matrix metalloproteinase-9, indicating degradation [144].…”

Section: Histologymentioning

confidence: 99%

Managing female pelvic floor disorders: a medical device review and appraisal

2019

View full text Add to dashboard Cite

Pelvic floor disorders (PFDs) will affect most women during their lifetime. Sequelae such as pelvic organ prolapse, stress urinary incontinence, chronic pain and dyspareunia significantly impact overall quality of life. Interventions to manage or eliminate symptoms from PFDs aim to restore support of the pelvic floor. Pessaries have been used to mechanically counteract PFDs for thousands of years, but do not offer a cure. By contrast, surgically implanted grafts or mesh offer patients a more permanent resolution but have been in wide use within the pelvis for less than 30 years. In this perspective review, we provide an overview of the main theories underpinning PFD pathogenesis and the animal models used to investigate it. We highlight the clinical outcomes of mesh and grafts before exploring studies performed to elucidate tissue level effects and bioengineering considerations. Considering recent turmoil surrounding transvaginal mesh, the role of pessaries, an impermanent method, is examined as a means to address patients with PFDs.

show abstract

Histopathology of excised midurethral sling mesh

Cited by 8 publications

References 19 publications

No Correlation Between Presenting Symptoms Prior to Suburethral Sling Removal and Explanted Pathology Findings Suggests No Need for Routine Microscopic Pathology Evaluation

No Correlation Between Presenting Symptoms Prior to Suburethral Sling Removal and Explanted Pathology Findings Suggests No Need for Routine Microscopic Pathology Evaluation

Tobacco use, immunosuppressive, chronic pain, and psychiatric conditions are prevalent in women with symptomatic mesh complications undergoing mesh removal surgery

Managing female pelvic floor disorders: a medical device review and appraisal

Contact Info

Product

Resources

About