Classification of mesh fiber exposure: comment

Abstract

Dear Editor,I read with interest the document “An InternationalUrogynecological Association (IUGA) / International Con-tinence Society (ICS) joint terminology and classificationof the complications related directly to the insertion ofprostheses (meshes, implants, tapes) and grafts in femalepelvic floor surgery” published in your respected journal[1] and in Neurourology and Urodynamics [2]. I find ituseful in standardizing terminology for the reporting ofcomplications related to grafts and prostheses.I wanted to highlight an issue that is encapsulated nicelyby the example of patient 333 in Table 4 of the article, withmesh fiber exposure reported as 1B. According to defi-nitions stated in the same document, category 1 should befor “Vaginal complication—no epithelial separation: Thisincorporates the terms prominence (e.g., due to wrinkling orfolding) or contraction (shrinkage). Also incorporated hereis the palpation of mesh fibres.” If fibers are protrudingthough the epithelium, then there must be some separationof epithelium; moreover, is this limited by only one thread?I think if mesh fiber is felt under the epitheliumwithout it being seen in the vagina, then this qualifies for1A. If there is any discontinuation of epithelium,however, even by one fiber, this should be reported as2B, as the management is different. In the case ofpalpation of fibers under the epithelium, without protru-sion through the epithelium, then the classificationshould be 2B rather than 1B.