Efficacy of surgical revision of mesh complications in prolapse and urinary incontinence surgery

Claudia R Kowalik,Jan-Paul W R Roovers,Mariëlle M E Lakeman,Sandra E Zwolsman

doi:10.1007/s00192-020-04543-7

Claudia R Kowalik, Jan-Paul W R Roovers + Show 2 more

Open Access

https://doi.org/10.1007/s00192-020-04543-7

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Journal: International Urogynecology Journal	Publication Date: Oct 9, 2020
Citations: 1	License type: open-access

Affiliation: University of Amsterdam

Abstract

Introduction and hypothesisWomen with mesh-related complications in prolapse (POP) and stress-urinary incontinence (SUI) surgery may benefit from operative mesh resection to alleviate symptoms. We hypothesized that mesh resection would alleviate symptoms and aimed to evaluate risks and benefits in these women.MethodsWe carried out a cross-sectional study. Primary outcome was improvement specified as better, unchanged or worsened symptoms after mesh revision surgery. Secondary outcomes were health-related quality of life (HrQol) scores of validated questionnaires, surgical characteristics and physical findings at follow-up visits. Descriptive data were reported with mean and medians. Associations were calculated with Spearman correlation coefficient and chi-square test to determine statistical differences between groups.ResultsFifty-nine women who underwent mesh revision surgery between 2009 and 2016 were included. After a median follow-up of 1.7 (IQR: 1.1–2.4) years, 44 women (75%) reported improvement of symptoms. No significant surgical or patient characteristics were identified that could differentiate which patients did or did not experience cure or complications.A trend was observed to better HrQol scores in women who reported overall improvement after mesh revision surgery. Seventeen (29%) women needed a subsequent operation after mesh removal.ConclusionsThis cross-sectional study shows that mesh revision surgery alleviates symptoms in 75% of women with mesh-related complications. Type of revision surgery and individual characteristics did not seem to matter to the individual chance of cure or complications. These data can facilitate the counseling of women considering mesh revision surgery.

Highlights

Introduction and hypothesisWomen with mesh-related complications in prolapse (POP) and stress-urinary incontinence (SUI) surgery may benefit from operative mesh resection to alleviate symptoms
We analyzed the outcomes of mesh re-interventions in our tertiary referral center to document the risks and benefits and relate outcomes to the type of intervention and individual characteristics. These data can facilitate the counseling of women considering mesh revision surgery
Women reporting improvement had better mean UDI-6 and IIQ-7 scores. This cross-sectional study demonstrates that 75% of women undergoing mesh revision surgery because of mesh-related complications after POP or SUI surgery experienced an improvement of symptoms, while in 5% symptoms worsened

Summary

Introduction

Women with mesh-related complications in prolapse (POP) and stress-urinary incontinence (SUI) surgery may benefit from operative mesh resection to alleviate symptoms. We hypothesized that mesh resection would alleviate symptoms and aimed to evaluate risks and benefits in these women. Various surgical procedures for POP exist, but the perfect operation combining optimal cure rates and minimal morbidity has yet to be found. The high failure rates of conventional surgery for POP resulted in the introduction of synthetic vaginal meshes [1]. Comparative studies have shown that the use of vaginal implants results in improved objective and subjective outcomes, there are studies that show no or limited benefit of the use of vaginal implants [2,3,4,5]. Synthetic mesh has found its place in incontinence surgery.

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