Mesh exposure and associated risk factors in women undergoing transvaginal prolapse repair with mesh.

Elizabeth A Frankman,Leslie Meyn,Marianna Alperin,Gary Sutkin,Halina M Zyczynski

doi:10.1155/2013/926313

Elizabeth A Frankman, Leslie Meyn + Show 3 more

Open Access

https://doi.org/10.1155/2013/926313

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Abstract

Objective. To determine frequency, rate, and risk factors associated with mesh exposure in women undergoing transvaginal prolapse repair with polypropylene mesh. Methods. Retrospective chart review was performed for all women who underwent Prolift Pelvic Floor Repair System (Gynecare, Somerville, NJ) between September 2005 and September 2008. Multivariable logistic regression was performed to identify risk factors for mesh exposure. Results. 201 women underwent Prolift. Mesh exposure occurred in 12% (24/201). Median time to mesh exposure was 62 days (range: 10–372). When mesh was placed in the anterior compartment, the frequency of mesh exposure was higher than that when mesh was placed in the posterior compartment (8.7% versus 2.9%, P = 0.04). Independent risk factors for mesh exposure were diabetes (AOR = 7.7, 95% CI 1.6–37.6; P = 0.01) and surgeon (AOR = 7.3, 95% CI 1.9–28.6; P = 0.004). Conclusion. Women with diabetes have a 7-fold increased risk for mesh exposure after transvaginal prolapse repair using Prolift. The variable rate of mesh exposure amongst surgeons may be related to technique. The anterior vaginal wall may be at higher risk of mesh exposure as compared to the posterior vaginal wall.

Highlights

Mesh augmentation has been widely adopted for pelvic floor reconstructive procedures [1]
We report a 12% frequency of mesh exposure following transvaginal polypropylene mesh insertion using the Prolift Pelvic Floor Repair System with a median duration of followup of 339 days
This frequency is similar to the data reported by the tension-free vaginal mesh (TVM) group [13] (12.3%) but higher than that reported by other authors [10, 11, 14]

Summary

Introduction

Mesh augmentation has been widely adopted for pelvic floor reconstructive procedures [1]. Sacral colpopexy is considered to be the “gold standard” surgical procedure based on favorable subjective and objective outcomes and a relatively low complication rate [2,3,4]. It has demonstrated superior durability when compared to transvaginal plication techniques using native tissues [2, 5]. Following FDA approval, transvaginal mesh kits were widely adopted with an estimated 75,000 transvaginal mesh procedures for prolapse performed in 2010 [6]

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Conclusion