Meshology: a fast-growing field involving mesh and/or tape removal procedures and their outcomes

Abstract

Stress urinary incontinence and pelvic organ prolapse are two of the commonest conditions affecting women today. It is associated with significant compromise to quality of life. Through the years, there has been an evolution of technique and graft material to augment repairs for durability. Transvaginal placements of synthetic mid-urethral slings and vaginal meshes have largely superseded traditional tissue repairs in the current era because of presumed efficacy and ease of implant with device 'kits'. The use of synthetic material has generated novel complications, including mesh extrusion, pelvic and vaginal pain and mesh contraction. In this review, our aim is to discuss the management and outcomes associated with mesh removal. In addition, we will briefly review the safety communications issued by the US FDA on transvaginal mesh placement and a new classification system for complications arising from the use of synthetic graft endorsed by both the International Continence Society and International Urogynecological Association.

Update on complications of synthetic suburethral slings

“…Since the FDA released a warning on the safety and effectiveness of trans-vaginal placement of meshes in 2011, the number of lawsuits has increased exponentially and has thus become a major concern to all vaginal surgeons. Given the potential risks involved, as well as the readily available legal recourse for patients who experience complications, it is important to deter litigation by appropriately counseling patients about the risks and documenting informed consent in the medical record ( 102 – 106 ).…”

Total trans-obturator tape (TOT) removal; a case series including pain and urinary continence outcomes

“…The 9-year risk of TOT removal in women who had a first mesh implant for SUI under NHS England between 2006 and 2016 was reported to be 2.7% [ 12 ]. Nonetheless, there is limited evidence on the indications for and benefits of partial or total mesh removal [ 13 , 14 ] and on long-term outcomes following mesh removal [ 13 , 15 ]. Therefore, it has become essential to perform a risk-benefit evaluation of mesh removal to help aid the clinicians and patients in decision making and to improve patient care.…”

Evaluation and Management of Mid-Urethral Sling Complications

“…Non-surgical therapies may be offered for minimal obstruction such as self-intermittent catheterization (SIC), indwelling catheterization, urethral dilation, medical management, or biofeedback [22]. However, these therapies are limited and surgical intervention is often necessary including: sling loosening, sling incision, sling excision, or urethrolysis (infrapubic, retropubic, or transvaginal) [54].…”