Effects of mesh-related complications in vaginal surgery on quality of life

Claudia R Kowalik,Mariëlle M E Lakeman,Alyde T De Kraker,Jan Paul W R Roovers

doi:10.1007/s00192-018-3680-9

Claudia R Kowalik, Mariëlle M E Lakeman + Show 2 more

Open Access

https://doi.org/10.1007/s00192-018-3680-9

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Abstract

Introduction and hypothesisVaginal mesh surgery is subject of debate due to the impact of mesh-related complications on patient’s lives. Not all of these complications are symptomatic. Restoration of the anatomy and improvement of pelvic floor function as a result may counter the experienced discomfort related to adverse events. We hypothesized that health-related quality of life (HR-QoL) is comparable in women after vaginal mesh surgery regardless of the presence or absence of a mesh-specific complication.MethodsThis was a cross-sectional study of 128 women who had vaginal mesh surgery in a Dutch university hospital between 2007 and 2012. HR-QoL was measured in women with and without mesh complications using standardized QoL questionnaires Urogenital Distress Inventory-6 (UDI-6), Incontinence Impact Questionnaire (IIQ), Defecation Distress Inventory (DDI), and Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire (PISQ-12). Complications were scored according to the International Urogynecological Association (IUGA) complication classification. Comparisons between groups were performed with Student’s t test and analysis of variance (ANOVA) test.ResultsIn 29 (23%) women, a mesh-related complication occurred. The domain scores of the UDI-6, DDI, IIQ, and PISQ showed no statistically significant differences between women with and without a mesh-related complication. A post hoc analysis showed similar HR-QoL for those in whom the complication had been resolved and those with persistent symptoms of the complication.ConclusionMesh surgery imposes specific complications. When counseling patients about the potential adverse events related to vaginal mesh surgery, it is important to inform them that mesh-related complications do not negatively affect QoL related to micturition, defecation, and sexual functioning.

Highlights

Introduction and hypothesisVaginal mesh surgery is subject of debate due to the impact of mesh-related complications on patient’s lives
The medical ethics committee of the Academic Medical Center (AMC) judged that the Medical Research Involving Human Subjects Act does not apply to this study, since the study only involved completing questionnaires and one additional pelvic floor examination that can be justified by the fact that mesh-related complications, if present, can be managed
Indications to perform vaginal mesh surgery were recurrence of POP, women with a posterior vaginal wall prolapse after previous vaginal hysterectomy, or women participating in studies to evaluate the outcomes of vaginal mesh surgery [7,8,9]

Summary

Introduction

Vaginal mesh surgery is subject of debate due to the impact of mesh-related complications on patient’s lives. In women with POP recurrence, a reoperation rate of 11.5% has recently been reported in a large Danish cohort study after 20 years of follow-up [2]. Altman and co-workers have shown that both objective and subjective cures are better following vaginal mesh surgery compared with native tissue repair. They reported a reintervention rate for mesh-related complications of 3.2%, Int Urogynecol J (2019) 30:1083–1089 but a recent multicenter randomized controlled trial (RCT) performed in the UK reported a reoperation risk for meshrelated complications in 9% of the patients [4, 5]. The risk on mesh-related complications was one of the main reasons for the US Food and Drug Administration (FDA) to issue public health notifications in 2008 and 2011 advising the restricted use of mesh and optimize patient counseling regarding the possible adverse events of mesh surgery [6]

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