MP75-17 PRESENTATION AND MANAGEMENT OF PATIENTS WITH MESH COMPLICATIONS: EXPERIENCE AT A SINGLE INSTITUION

Abstract

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Female Urology II1 Apr 2014MP75-17 PRESENTATION AND MANAGEMENT OF PATIENTS WITH MESH COMPLICATIONS: EXPERIENCE AT A SINGLE INSTITUION Leah Nakamura, Judy Choi, Diana Kang, Erin Mellano, Tamara Hartshorn, Z. Chad Baxter, Ja Hong Kim, Larissa Rodriguez, and Shlomo Raz Leah NakamuraLeah Nakamura More articles by this author , Judy ChoiJudy Choi More articles by this author , Diana KangDiana Kang More articles by this author , Erin MellanoErin Mellano More articles by this author , Tamara HartshornTamara Hartshorn More articles by this author , Z. Chad BaxterZ. Chad Baxter More articles by this author , Ja Hong KimJa Hong Kim More articles by this author , Larissa RodriguezLarissa Rodriguez More articles by this author , and Shlomo RazShlomo Raz More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2390AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Transvaginal mesh has been utilized for the treatment of pelvic organ prolapse (POP) and urinary incontinence for many years. Recently there has been an increase in the number of mesh complications seen, especially at tertiary referral centers. This study aimed to evaluate the trends in patients presenting with mesh complications and how management has changed over time at a single institution. METHODS A retrospective review was performed on women who presented to our institution with complications related to the placement of transvaginal mesh between June 2009 and February 2013. Patients were identified through CPT codes for revision of a prosthetic vaginal graft or sling and/or if they had an evaluation including a translabial US for mesh. Only patients who had synthetic transvaginal mesh for pelvic organ prolapse or urinary incontinence were included in the analysis. The FDA warning update on transvaginal mesh was reported in 2011, therefore overall trends were divided into the time periods before and after June 2011. Demographics and variables were obtained from medical records. Statistical analysis was performed using t-tests and chi square analysis. RESULTS There were 468 patients who presented with transvaginal mesh complications. Out of these patients, 420 went on to have surgery. The tables below display the results broken down before and after June 2011 CONCLUSIONS After the FDA update in 2011, there has been an increasing number of referred cases of mesh complications. Operative time is slightly longer likely secondary to more cases of complete mesh removal. More patients are presenting with pain, dyspaureunia, complications of sacrocolpopexy and systemic complaints. There are less patients presenting with incontinence and mesh exposure. Demographics of patients with mesh complications Before June 2011 (n=205) After June 2011 (n=263) P value Mean Age (years) 58.7 57.9 0.54 Mean BMI (kg/m2) 26.5 28.1 0.003 Mean operative time (minutes) 74 104.5 <0.001 Mean mesh removed (cm) 9.8 8.4 0.79 Mean number of operations 2.6 1.5 <0.001 Sling only (percentage of patients) 52% 57% Prolapse mesh +/- sling (percentage of patients) 46% 36% Sacrocolpopexy +/- sling (percentage of patients) 2% 7% Outside referrals (percentage of patients) 69.8% 89.3% Complete mesh removal (percentage of patients) 9% 37% Presenting complaints of patients with mesh complications Presenting complaint Before June 2011 After June 2011 Urinary tract infections 35.5% 43.8% Pain 59.2% 73.2% Dyspareunia 45.6% 60.5% Obstruction/retention 45% 46.9% Mesh exposure 60.2% 42% Incontinence 62.7% 47% Bowel complaints 15.4% 14.1% Systemic complaints 3% 15.5% © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e880 Peer Review Report Advertisement Copyright & Permissions© 2014MetricsAuthor Information Leah Nakamura More articles by this author Judy Choi More articles by this author Diana Kang More articles by this author Erin Mellano More articles by this author Tamara Hartshorn More articles by this author Z. Chad Baxter More articles by this author Ja Hong Kim More articles by this author Larissa Rodriguez More articles by this author Shlomo Raz More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...