Long-Term Follow-up of Treatment for Synthetic Mesh Complications

Abstract

Transvaginal synthetic mesh products were introduced more than 10 years ago to improve success rates of traditional pelvic organ prolapse and stress urinary incontinence repair methods. However, limited data are available showing symptomatic benefits of transvaginal mesh use. Moreover, with increased use of vaginal mesh, there has been increasing incidence of mesh complications, including vaginal mesh exposure and contraction. Although several treatments of mesh complications have been investigated, it is unclear whether these treatments alleviate their symptoms, especially long-term. This retrospective study had 2 aims. The first was to describe the presenting symptoms, findings, and treatment of complications resulting from placement of synthetic vaginal mesh. The second was to describe the self-reported improvement and function at least 6 months after treatment of complications. Women presenting with mesh complications at a single urogynecology center between 2006 and 2011 were identified by diagnostic codes. Data were abstracted from a chart review of medical records; the women were asked to complete a follow-up questionnaire consisting of several validated survey instruments. One hundred eleven women met criteria for inclusion and were evaluated for complications associated with synthetic mesh. The mean interval from the placement of mesh to presentation for evaluation of symptoms was 2.4 years. Of the 111 women, 93 (84%) were referred from outside hospitals. Mesh complications occurred with the following index surgeries: vaginal mesh kits/vaginally placed mesh (47%), midurethral mesh slings (38%), abdominally placed vaginal mesh (11%), and vaginal mesh kit with concomitantly placed mesh sling (4.5%). The most common complications reported were mesh extrusion (65%), mesh contraction (17%), chronic pelvic pain (16%), and obstructive voiding (9%). Ninety-eight women (88%) underwent multidisciplinary treatment by urogynecologists, pelvic pain specialists, or physical therapists; 85 (87%) of these underwent mesh excision. Follow-up data were provided by 84 (76%) of the patients at a mean interval since management of the complication of 2.3 years. At follow-up, the mean (SD) Pelvic Floor Distress Inventory and EuroQol-5 Dimension questionnaire index scores were 98 (67) and 0.69 (0.23), respectively. Vaginal discharge was reported by 22% of the women; 15% had vaginal bleeding or spotting, and 45% sexually inactive women were abstinent because of mesh-related problems. At follow-up, 71% of the women reported being overall better than their status when presenting with the mesh complication, whereas 29% were the same or worse. These data show that, 2 years after multidisciplinary treatment of vaginal mesh complications, symptoms are still reported that negatively impact quality of life. Mesh complications are difficult to treat successfully. Most patients require surgical intervention.