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Management of Mesh Complications after SUI and POP Repair: Review and Analysis of the Current Literature.

Barski D, Deng DY - Biomed Res Int (2015)

Bottom Line: Prior to recurrent surgeries, a careful examination and planning for the operation strategy are crucial.The data on the management of mesh complication is scarce.Revisions should be performed by an experienced surgeon and a proper follow-up with prospective documentation is essential for a good outcome.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Lukas Hospital, Preussenstrasse 84, 41464 Neuss, Germany.

ABSTRACT

Purpose: To evaluate the surgical treatment concepts for the complications related to the implantation of mesh material for urogynecological indications.

Materials and methods: A review of the current literature on PubMed was performed.

Results: Only retrospective studies were detected. The rate of mesh-related complications is about 15-25% and mesh erosion is up to 10% for POP and SUI repair. Mesh explantation is necessary in about 1-2% of patients due to complications. The initial approach appears to be an early surgical treatment with partial or complete mesh resection. Vaginal and endoscopic access for mesh resection is favored. Prior to recurrent surgeries, a careful examination and planning for the operation strategy are crucial.

Conclusions: The data on the management of mesh complication is scarce. Revisions should be performed by an experienced surgeon and a proper follow-up with prospective documentation is essential for a good outcome.

No MeSH data available.


Related in: MedlinePlus

Treatment failure risk for mesh-related complication after conservative treatment versus mesh excision. CI: confidence interval; M-H: Mantel-Haenszel [15–17, 20].
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Related In: Results  -  Collection


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fig1: Treatment failure risk for mesh-related complication after conservative treatment versus mesh excision. CI: confidence interval; M-H: Mantel-Haenszel [15–17, 20].

Mentions: The current retrospective data on mesh excision for complications is presented in Table 1. 12 trials reported on complications after MUS, 8 trials on complications after transvaginal mesh for POP repair, and 3 trials on abdominal colposacropexy. Median patient number in the studies was 42 patients (8–347). Mean follow-up after the treatment of mesh-related complications was 22.6 mos (6 weeks–65 mos). Many authors propagate an initial conservative approach with antibiotics and local estrogen application in cases of mesh erosion. However, new studies show an advantage of the timely revision surgery to relieve the symptoms. The analysis of trials comparing conservative treatment with surgery for mesh erosions showed a 4.32-fold risk ratio for treatment failure after the conservative approach (Figure 1). Abbott and colleagues showed that 60% of the initially conservatively treated patients required surgical intervention and 60% of the total cohort were operated on at least twice [17]. Erosions in the vagina or internal organs with consecutive infection, pain, dys- or hispareunia, voiding dysfunction due to obstruction, and urge incontinence often require surgical revision [25]. In the current US-American and European studies with long-term observation, the rate of postoperative mesh explantations was about 1% after a midurethral sling (MUS) and about 3% after a vaginal mesh for POP repair [26, 32]. The complications can be often corrected by mesh resection, but, in some cases, further surgeries for de novo incontinence (10–25%) or POP (7–47%) were necessary [17]. Figure 2 shows the percentage of recurrent stress incontinence depending on different MUS-excision techniques. Laparoscopic abdominal resection causes a 3-fold higher risk of Re-SUI probably due to a complete incision and excision of the mesh arms [30]. The result was however not significant due to a small trial number. There are a few data on the effect of mesh explantation on dyspareunia and chronic pelvic pain. Previous studies suggest that the pain due to the scarring and foreign body reaction may persist even after the mesh removal [33].


Management of Mesh Complications after SUI and POP Repair: Review and Analysis of the Current Literature.

Barski D, Deng DY - Biomed Res Int (2015)

Treatment failure risk for mesh-related complication after conservative treatment versus mesh excision. CI: confidence interval; M-H: Mantel-Haenszel [15–17, 20].
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4418012&req=5

fig1: Treatment failure risk for mesh-related complication after conservative treatment versus mesh excision. CI: confidence interval; M-H: Mantel-Haenszel [15–17, 20].
Mentions: The current retrospective data on mesh excision for complications is presented in Table 1. 12 trials reported on complications after MUS, 8 trials on complications after transvaginal mesh for POP repair, and 3 trials on abdominal colposacropexy. Median patient number in the studies was 42 patients (8–347). Mean follow-up after the treatment of mesh-related complications was 22.6 mos (6 weeks–65 mos). Many authors propagate an initial conservative approach with antibiotics and local estrogen application in cases of mesh erosion. However, new studies show an advantage of the timely revision surgery to relieve the symptoms. The analysis of trials comparing conservative treatment with surgery for mesh erosions showed a 4.32-fold risk ratio for treatment failure after the conservative approach (Figure 1). Abbott and colleagues showed that 60% of the initially conservatively treated patients required surgical intervention and 60% of the total cohort were operated on at least twice [17]. Erosions in the vagina or internal organs with consecutive infection, pain, dys- or hispareunia, voiding dysfunction due to obstruction, and urge incontinence often require surgical revision [25]. In the current US-American and European studies with long-term observation, the rate of postoperative mesh explantations was about 1% after a midurethral sling (MUS) and about 3% after a vaginal mesh for POP repair [26, 32]. The complications can be often corrected by mesh resection, but, in some cases, further surgeries for de novo incontinence (10–25%) or POP (7–47%) were necessary [17]. Figure 2 shows the percentage of recurrent stress incontinence depending on different MUS-excision techniques. Laparoscopic abdominal resection causes a 3-fold higher risk of Re-SUI probably due to a complete incision and excision of the mesh arms [30]. The result was however not significant due to a small trial number. There are a few data on the effect of mesh explantation on dyspareunia and chronic pelvic pain. Previous studies suggest that the pain due to the scarring and foreign body reaction may persist even after the mesh removal [33].

Bottom Line: Prior to recurrent surgeries, a careful examination and planning for the operation strategy are crucial.The data on the management of mesh complication is scarce.Revisions should be performed by an experienced surgeon and a proper follow-up with prospective documentation is essential for a good outcome.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Lukas Hospital, Preussenstrasse 84, 41464 Neuss, Germany.

ABSTRACT

Purpose: To evaluate the surgical treatment concepts for the complications related to the implantation of mesh material for urogynecological indications.

Materials and methods: A review of the current literature on PubMed was performed.

Results: Only retrospective studies were detected. The rate of mesh-related complications is about 15-25% and mesh erosion is up to 10% for POP and SUI repair. Mesh explantation is necessary in about 1-2% of patients due to complications. The initial approach appears to be an early surgical treatment with partial or complete mesh resection. Vaginal and endoscopic access for mesh resection is favored. Prior to recurrent surgeries, a careful examination and planning for the operation strategy are crucial.

Conclusions: The data on the management of mesh complication is scarce. Revisions should be performed by an experienced surgeon and a proper follow-up with prospective documentation is essential for a good outcome.

No MeSH data available.


Related in: MedlinePlus