Table 1.
Studies on management of mesh related complications after incontinence and prolapse surgeries.
| Author | Trial | Number of patients | Mesh | Complications | Median time to revision | Management | Concomitant procedure | Follow-up |
|---|---|---|---|---|---|---|---|---|
| Abbot et al. 2014 [17] |
RT | 347 (49.9% MUS; 25.6% TVM or CSP; 24.2% combination) | Various | 30% dyspareunia 42.7% mesh erosion 34.6% pelvic pain 77% grade 3 or 4 (reoperation) complication |
5.8 mos (0–65.2 mos) | (1) Trimming of mesh/partial excision (50.9%) (2) Release of mesh arms (18.1%) (3) Complete intravaginal mesh excision (26.9%) (4) Recurrent prolapse treatment (23.2%) (5) Recurrent incontinence treatment (14.8%) (6) Other surgeries (20.1%) (7) Initial conservative treatment (23%) 60% ≥2 interventions |
MUS | |
|
| ||||||||
| Agnew et al. 2012 [18] |
RT | 63 MUS | Various synthetics (67% monofilament TVT, 17% TOT) | 100% voiding dysfunction | 12.4 mos (1 week–8 yrs) | (1) Simple sling division (73%) (2) Partial excision of sling (21%) (3) Concomitant procedure to prevent Re-SUI (4/63) |
Burch, MUS | Persistent voiding dysfunction (1) 10.9%; (2) 7.7%; (3) 50% (P = 0.09) Subsequent surgery for recurrent SUI (1) 2.2%; (2) 23.1%; (3) 0% (P = 0.04) De novo urgency (1) 10.9%; (2) 15.4%; (3) 25% (P = 0.51) |
|
| ||||||||
| Blaivas et al. 2013 [19] |
RT | 47 MUS | Type 1 76% Types 2–3 23% |
OAB (70%) SUI (55%) Recurrent UTI (21%) Pelvic pain/dysuria (34%) Obstructive symptoms (9%) Vaginal extrusion (9%) |
2 yrs (1 mos–8 yrs) | (1) Sling excision + urethrolysis (34%) (2) Sling excision + urethral reconstruction (including fistula repair) + autologous fascial sling (30%) (3) Sling incision (21%) (4) Partial cystectomy (10%) (5) Ureteroneocystostomy (4%) |
MUS | 2 yrs (0.25–12 yrs) Successful treatment 72% 28% recurrent surgery refractory pain (19%), mesh extrusion (17%), and OAB (8%) |
|
| ||||||||
| Costantini et al. 2011 [20] |
RT | 12 (12/179, 6.7%) mesh erosion after abdominal CSP | 11 PP, 1 Gore-Tex | 100% mesh erosion 41% vaginal bleeding 33% asymptomatic 17% dyspareunia 17% infection (1x Gore-Tex) |
22.9 mos (2–66 mos) | (1) Antibiotics and local estrogen (100%) (2) Vaginal (partial) mesh resection (83%) (3) Abdominal resection (17%) (4) Endoscopic (8%) |
57 mos (18–120 mos) (1) All needed surgery (3) Recurrent cystocele (4) Fistula, abdominal revision |
|
|
| ||||||||
| Davis et al. 2012 [21] |
RT | 12 TVT | PP | 100% mesh erosion | 59 mos (7–144 mos) | Endoscopic holmium: YAG laser excision (100%) | 65.5 mos (6–134 mos) 33% second laser excision 17% surgery for recurrent SUI 8% (1 patient) abdominal mesh resection |
|
|
| ||||||||
| Firoozi et al. 2012 [22] |
RT | 23 TVM for POP | Various PP | Vaginal/pelvic pain (39%), dyspareunia (39%), vaginal mesh extrusion/exposure (26%), urinary incontinence (35%), recurrent pelvic organ prolapse (22%), bladder mesh perforation (22%), rectal mesh perforation (4%), ureteral perforation injury (4%), and vesicovaginal fistula (9%) | 10 mos (1–27 mos) | (1) Transvaginal excision (90%) (2) Transvaginal/endoscopic (5%) (3) Transrectal/transperineal (5%) (4) Concomitant POP/SUI repair (45%) |
TVM, MUS | 3 mos 14% UTI 4.3% collagen injection for Re-SUI 4.3% PFT for perineal pain |
|
| ||||||||
| Greiman and Kielb 2012 [23] | RT | 28 (28/118, 23%) MUS | PP | Intravesical sling (4%), extruded vaginal mesh (93%), obstructive voiding symptoms (78%), dyspareunia (42%), and vaginal bleeding (21%) | 15 mos | (1) Sling loosening, incision in the midline (2) If mesh erosion >1 cm a resection |
11% reoperation for mesh extrusion, no other complications | |
|
| ||||||||
| Hammett et al. 2014 [24] |
RT | 57 patients (26 MUS, 23 TVM, and 9 intraperitoneal prolapse CSP) | Various PP | 100% mesh erosion with pelvic pain (55.9%), dyspareunia (54.4%), and vaginal discharge (30.9%). | (1) Vaginal mesh excision (91%) (2) Abdominal resection (all CSP, n = 9/15, 40%) |
6 weeks 57% symptoms completely resolved 12% required more than 1 surgery for mesh excision (1) 9% UTI (2) 4.5% cardiopulmonal complications; 18% sepsis; 45% wound infection |
||
|
| ||||||||
| Hampel et al. 2009 [25] |
RT | 48 MUS (44 TVT, 4 TOT) | Various PP | De novo urge (65%), mesh erosion (21%), dyspareunia (19%), UTI (35%), and fistula (6%) | (1) Partial mesh resection (trans-/suburethral, 23%) (2) Self-catheterisation (23%) (3) Botox/neuromodulation (27%) (4) Fascia plastic (10%) (5) Complete abdominal-vaginal mesh resection (8%) (6) Urinary diversion (2%) (7) Fistula repair (6%) (8) Conservative treatment (25%) |
42% symptoms completely resolved | ||
|
| ||||||||
| Kasyan et al. 2014 [15] |
RT | 152 TVM | Prolift (Gynecare), PP | Erosions (21%), dyspareunia (11%), mesh shrinkage (4.4%), pelvic abscess (2.7%), and fistula (1.3%) | (1) Conservative treatment with local oestrogen (2) Partial/total mesh excision |
|||
|
| ||||||||
| Nguyen et al. 2012 [26] |
RT | 82 MUS (2.2%) | Various | (1) Sling loosening or transaction for voiding dysfunction (60%) (2) Excision for vaginal mesh exposure 30 (36%) (3) Excision for pain (1.2%) (4) Excision for urethral erosion (1.2%) (5) Drainage of retropubic hematoma (1.2%) |
MUS, colporrhaphy, and CSP | |||
|
| ||||||||
| Abdel-Fattah et al. 2006 [16] | RT | 34 TVM (2.2%) | Various | (1) Excision for vaginal mesh exposure (85%) (2) Excision of vaginal suture (6%) (3) Biologic graft reoperation (12%) (4) Drainage hematoma/abscess (6%) (5) Bowel resection for obstruction (3%) |
||||
|
| ||||||||
| Padmanabhan et al. 2012 [27] |
RT | 85 (MUS, TVM) | Various PP | Perforation of urethra (14%), bladder (36%), and vagina (50%) | (1) Vaginal excision (14%) (2) Lower urinary tract excision (47%) (3) Partial cystectomy (21%) (4) Urethroplasty (21%) |
Subjective cure in 75% and improvement in 21% SUI (6.6–12.5%) | ||
|
| ||||||||
| Renezeder et al. 2011 [28] |
RT | 118 (80% MUS, 20% TVM) | Various PP (88% type 1) | De novo urgency (46.6%), dyspareunia (41.5%), recurrent UTI (39.0%), mesh erosion (37%), and vaginal bleeding (9.3%) | 27 mos (1–89 mos) | (1) Tissue patch covering (17.8%) (2) Partial removal (65.3%) (3) Complete removal per laparotomy (12.7%) (4) Bone stabilization (0.8%) (5) Excision of granulation tissue (3.4%) |
8 weeks 45.5% urgency |
|
|
| ||||||||
| Ridgeway et al. 2008 [29] | RT | 19 TVM | Monofilament PP | Chronic pain (31%), dyspareunia (31%), recurrent pelvic organ prolapse (42%), mesh erosion (63%), and vesicovaginal fistula (16%) | Partial tailored vaginal mesh resection with concomitant procedures | Burch, MUS | 33 weeks (16–75 weeks) 16% UTI 5% hematoma 21% persistent symptoms |
|
|
| ||||||||
| Rouprêt et al. 2010 [30] | RT | 38 TVT | PP | Mesh erosion/extrusion (42%), pelvic pain (39%), and obstruction (18%) | (1) Laparoscopic (97%) (2) Laparoscopic + vaginal (3%) |
38 mos (2–80) Healing and pain release (100%) Recurrent SUI (66%) |
||
|
| ||||||||
| Shah et al. 2013 [31] |
RT | 21 MUS | Polypropylene, type I | Urethral perforation (67%), bladder perforation (33%), fistula (19%), vaginal pain (67%), urgency (29%), incontinence (38%), obstruction (33%), dyspareunia (19%), and hematuria (24%) | 15.5 mos (1–60 mos) | (near) Total mesh excision, urinary tract reconstruction, and concomitant pubovaginal sling with autologous rectus fascia | MUS, urethroplasty | 22 mos (6–98 mos) Continence (81%) Incisional seroma (9.5%) Additional procedures (36%) UTI (9.5%) Pelvic pain (9.5%) dyspareunia 9.5% |
RT: retrospective trial; PT: prospective trial; MUS: midurethral sling; TVM: transvaginal mesh; TVT: tension-free vaginal tape; TOT: transobturator tape; CSP: colposacropexy; PP: polypropylene.