Mesh-related chronic infections in silicone-coated polyester suburethral slings

Abstract

the silicone-coated mesh of the AMS InFAST sling, can become a focus for chronic infection forming a sinus tract into the vagina or other viscus, causing symptoms years after its placement.

Histopathology of excised midurethral sling mesh

“…Review of the literature shows that the risk of mesh exposure/erosion after midurethral sling placement ranges from 0.3 to 5.9 % [2][3][4]. Risk factors associated with mesh exposure/erosion include younger age at time of placement [5], concomitant prolapse surgery [5], and certain synthetic mesh materials [6,7].…”

Safety considerations for synthetic sling surgery

“…Types II-IV meshes, including PTFE mesh (Amid Type II), silicon-coated polyethylene or polyester (Amid Type IV) and non-knitted, nonwoven mesh such as OBTAPE® and UraTape® (both Mentor-Porges, Le Plessis Robinson, France), have been documented to have a much higher incidence of erosion (16-25%) c ompared with that of type I meshes (0-10%). 105,109,124,301 As described previously, bladder, urethral or vaginal perforation during the original surgery increases the risk of subsequent sling erosion by approximately 26-fold. 31 In addition, passage of the trocar through the vaginal, bladder or urethral wall without actually penetrating the lumen might occur, which would result in positioning of the mesh just barely under the surface of the lumen and predisposing it to erosion.…”

“…6 Furthermore, this study 6 excluded patients whose slings were removed owing to pain and other indications, thus the actual incidence of sling removal owing to complications is probably even higher than that. Extrapolating from this estimate and the estimated number of slings implanted in the 6,9,10,41,44,[100][101][102][103][104][105][106][107][108][109][110][111][112][113][114] Use of imperfect research methodologies, a lack of long-term follow up and reporting bias have been suggested as causes of these differences. 10,45,115,116 Safety and risk:benefit considerations Safety of SMUS surgery refers to the probability of any adverse event, while risk describes the range and probability of specific adverse events.…”

Surgical Complications with Synthetic Materials

“…At 14 months follow up, she experienced severe pelvic pain and vaginal discharge. Clinical examination revealed hyperthermia to 40 0 C, sling exposure at right vaginal sulcus and severe cellulitis in the genital-crural fold: Classification: 3C T4 S 2 and 6C T4 S3 Lee et al(2011) in four of the five patients presented with symptom of chronic vaginal discharge and these patients have a chronic infection forming a sinus tract into the vagina or other viscus, causing symptoms years after its mesh placement. Rajendra et al (2011) reported after a 3 year follow up, that 11 patients with TVT-O (2.6%) (11/419) were readmitted since 10 patients had voiding dysfunction, in 6 patients it was necessary to remove or cut the tape.…”