Management of Vaginal Synthetic Graft Extrusion following Surgery for Stress Urinary Incontinence and Prolapse

Abstract

Objective: The optimal management of vaginal mesh extrusion placed during incontinence and prolapse repairs has not been well defined. We reviewed our experience with these patients following aggressive surgical resection to assess treatment outcomes. Patients and Methods: Over a 3-year period, 27 patients were referred for the vaginal extrusion of mesh after surgery for stress urinary incontinence or pelvic organ prolapse. Presenting complaints included vaginal discharge, sensation of foreign body, pain syndrome, dyspareunia, or partner sensitivity during coitus. All patients ultimately required aggressive surgical mesh resection under anesthesia with circumferential mobilization of vaginal wall and primary closure. Patients were followed for recurrence of erosion and baseline symptoms. Results: The majority of patients (15/27, 56%) presented with vaginal discharge or bleeding as their primary complaint. Conservative management with topical estrogen cream and/or in-office trimming of mesh was attempted in 9/27 (33%) of patients and 8/27 (30%) had one or more previously attempted graft removals prior to presentation. At most recent follow-up (mean 7.2 months, range 0.5–32.5 months), all patients had complete resolution of symptoms related to mesh extrusion and no further recurrence of extrusion. Conclusions: Excellent out-comes following vaginal mesh extrusion can be achieved by complete resection of exposed mesh under anesthesia followed by primary closure. Consideration should be given to this aggressive approach immediately after mesh extrusion is diagnosed for motivated patients who desire a definitive solution.