Mesh Erosion After Anterior Prosthetic Reinforcement by Vaginal Route: Risk Factors and Management

Abstract

Vaginal erosion has been reported in up to 20% of women having repair of a cystocele, but this may be an underestimate. This retrospective chart review collected information on 247 consecutive women who, in the years 2001–2004, underwent a vaginal prosthetic mesh reinforcement for cystocele (n = 77); a suburethral sling urethropexy for stress urinary incontinence, or SUI (n = 122), or both procedures (n = 48). Women having a suburethral sling urethropexy and concomitant abdominal sacral colpopexy were excluded. Three senior surgeons performed all operations. Eighteen women, 7.3% of those operated on, had mesh exposure during follow up for 2 years or longer. The most common symptoms were transient vaginal pain and leucorrhea. Risk factors included a past history of vaginal surgery, a lack of antibiotic prophylaxis, and absence of an indwelling urethral catheter. All those affected required surgical treatment, and 10 of the 18 patients needed a second operation. Four women (22%) had persistent disorders. Factors associated with mesh erosion remain to be clearly identified. The investigators believe that mesh should be avoided, particularly in “primary” repairs, until it is shown conclusively to be better than a nongraft repair. When mesh exposure does take place, as much as possible of the prosthetic material should be excised under antibiotic coverage.