2145 ANTERIOR TRANSVAGINAL MESH- HOW “SERIOUS” ARE THE COMPLICATIONS AND ARE THEY REVERSIBLE?

Abstract

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Pelvic Prolapse1 Apr 20122145 ANTERIOR TRANSVAGINAL MESH- HOW “SERIOUS” ARE THE COMPLICATIONS AND ARE THEY REVERSIBLE? Dominic Lee, Benjamin Dillon, Gary Lemack, Alexander Gomelsky, and Philippe Zimmern Dominic LeeDominic Lee Dallas, TX More articles by this author , Benjamin DillonBenjamin Dillon Dallas, TX More articles by this author , Gary LemackGary Lemack Dallas, TX More articles by this author , Alexander GomelskyAlexander Gomelsky Shreveport, LA More articles by this author , and Philippe ZimmernPhilippe Zimmern Dallas, TX More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.2316AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Following two FDA warnings on the use of trans-vaginal mesh in women with pelvic organ prolapse, we reviewed our series of patients referred with anterior mesh related complications. METHODS Following IRB approval, a retrospective analysis of pooled data from 2 tertiary institutions managing complications of anterior transvaginal mesh (ATM) from 2006 to March 2011 was conducted. Data recorded included mesh type, symptoms leading to surgical removal, and clinical outcome. Minimal follow-up was 6 months. RESULTS Fifty-eight women underwent anterior vaginal wall mesh removal. Mean age was 54.6 years (range: 32-80) and duration of follow-up 13.3 months (range: 6-67.3). Time from original surgery to mesh excision was 20.9 months (range: 2.2-59.8). Overall, 44 patients had removal of ATM mesh only, while 31 of 44 had mid urethral sling (MUS) takedown as well. Fourteen patients had ATM removal combined with apical and/or posterior mesh removal and of these, 9 also had MUS takedown. ProliftTM was the predominant mesh kit material (28), followed by PerigeeTM (14), AvaultaTM (10) and various others (8). Nineteen of 58 patients (32.7%) had prior mesh removal attempts. Vaginal mesh extrusion (75%), dyspareunia (73%) and pelvic pain (41%) were the commonest presenting complaint, in addition to one case of vesico-vaginal fistula. Three cases required an abdominal approach. Seventy-four surgeries were required for maximal anterior mesh excision. Thirteen additional procedures were required for recurrent cystocele (4) and secondary stress urinary incontinence (9). Forty-two of 58 were women remained sexually active (73%) postoperatively and reported improvement in dyspareunia with 18 having no pain (42.8%), 12 mild pain (28.6%) and 3 moderate pain (7.1%). Chronic pelvic pain was improved in most patients with 7 women reporting no pain (30.4%), 9 mild pain (39.1%) and 5 moderate pain (21.7%). Two patients had mesh erosion recurrence, and 1 intra-operative ureteric injury was successfully repaired primarily on mesh removal. CONCLUSIONS : In this combined series, ATM removal provided symptom relief in over 75% of women. Residual issues of dyspareunia, chronic pelvic pain, prolapse recurrence, and recurrent mesh extrusion remain in a substantial minority. Some ATM complications are life-altering and intervention “may or may not correct the complication” [FDA October 2008]. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e866 Peer Review Report Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Dominic Lee Dallas, TX More articles by this author Benjamin Dillon Dallas, TX More articles by this author Gary Lemack Dallas, TX More articles by this author Alexander Gomelsky Shreveport, LA More articles by this author Philippe Zimmern Dallas, TX More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...