Management of vaginal mesh exposure: A systematic review

Abstract

Objectives: To identify various predisposing factors, the clinical presentation, and the management of vaginal mesh-related complications, with special emphasis on mesh exposure and the indications for and results of vaginal mesh removal. Methods: A systematic literature review was performed using a search strategy based on the Preferred Reporting Items for Systematic Reviews and Meta-analyses criteria. PubMed was queried for studies regarding aetiology, risk factors, and management of vaginal mesh exposure from 1 January 2008 to June 2018. Full-text articles were obtained for eligible abstracts. Relevant articles were included, and the cited references were used to identify relevant articles not previously included. Results: A total of 102 abstracts were identified from the PubMed search criteria. An additional 45 studies were identified based on review of the cited references. After applying eligibility criteria and excluding impertinent articles, 58 studies were included in the final analysis. Conclusion: Numerous studies have found at least some degree of symptomatic improvement regardless of the amount of mesh removed. Focal areas of exposure or pain can be successfully managed with partial mesh removal with low rates of complications. With partial mesh removal, many patients will ultimately require subsequent mesh removal procedures. For this reason, complete mesh excision is an alternative for patients with diffuse vaginal pain, large mesh exposure, and extrusion of mesh into adjacent viscera. However, when considering complete mesh removal, it is important to counsel patients regarding possible complications of removal and the increased risk of recurrent stress urinary incontinence and pelvic organ prolapse postoperatively.

Recurrent surgery in uterine prolapse: A nationwide register study

“…Mesh exposure, when the mesh is visualized through the vaginal epithelium, is a known complication with exposure rates range from 2% to 30% following prolapse surgery or sling surgery. 22 This study showed a low reoperation and symptomatic recurrence rate when using vaginal lighter mesh in SSHP in uterine prolapse compared to other methods. Notably, the MP was not inferior to SSHP with graft in the primary outcome.…”

“…Inspired by mesh used in surgery for stress urinary incontinence, several meshes were introduced in 2000 in POP surgery. Mesh exposure, when the mesh is visualized through the vaginal epithelium, is a known complication with exposure rates range from 2% to 30% following prolapse surgery or sling surgery 22 . This study showed a low reoperation and symptomatic recurrence rate when using vaginal lighter mesh in SSHP in uterine prolapse compared to other methods.…”

Prevention of vault prolapse in cases of procedentia using combined vaginal and laparoscopic approach for vault suspension: Agrawal’s technique

“…Bergersen et al also advocated that conservative management may be attempted for asymptomatic mesh exposure. 12 The overall incidence of mesh erosion has been up to 9% with Marlex gore tex and Merselene, up to 11% with Teflon. Shah et al found that incidence of mesh erosion (including exposure, extrusion and perforation varies from 0-33%.…”

Comparison of Two Single-Incision Mini-Slings for the Treatment of Incontinence

“…Excessive tension of the mesh, intense sexual intercourse during early postoperative period, and/or mesh characteristics are the factors that are blamed for the mesh erosions. Local excision and local estrogen therapy are the recommended choices in the treatment of mesh erosions [25, 26].…”