Mesh For Pelvic Organ Prolapse Research Articles

Diagnosis and treatment of abdominally inserted (sacrocolpopexy/sacrohysteropexy) mesh complications for vault/uterine prolapse

Background:Sacrohysteropexy and sacrocolpopexy are established treatments of uterine or vaginal vault prolapse respectively and involve insertion of mesh abdominally, often using permanent sutures and fixation devices. Complications following these procedures may be serious, and there is lack of evidence about long-term functional outcomes in terms of pain, dyspareunia and development of lower urinary tract and bowel symptoms. Objective:A non-systematic review of the available literature was performed and recommendations on assessment and management were developed by expert consensus. Conclusion:The current evidence is limited in quantity and quality, and recommendations on assessment management of mesh-related complications were made by experts in the field. Assessment and treatment of complications following abdominally placed mesh for pelvic organ prolapse will often require a multidisciplinary approach. Assessment may require EUA, and/or cystourethroscopy, sigmoidoscopy, and laparoscopy. MRI is the most useful imaging modality. Surgery to remove meshcarries a risk of urinary tract and bowel injury, as well as development of recurrent pelvic organ prolapse. A joint decision between the surgeon and the patient should be made before embarking on a partial removal of mesh; removal of all the mesh may be a better option albeit with higher risk of surgical complications. Complete removal of mesh and tacks or sutures from the sacral attachment may not be possible and is associated with risk of major haemorrhage.

Diagnosis and treatment of vaginally inserted pelvic organ prolapse mesh complications

Diagnosis and treatment of vaginally inserted pelvic organ prolapse mesh complications

The long-term impact of vaginal surgical mesh devices on pain clinic and psychological service referrals, anti-inflammatory testing and pelvic scans in UK primary care: A cohort study with the Clinical Practice Research Datalink.

To examine long-term complications in women with stress urinary incontinence (SUI) and pelvic organ prolapse (POP), with and without surgical mesh implants. Longitudinal open cohort study from 1 April 2006 (or 1 April 2012) to 30 November 2018. The Clinical Practice Research Datalink (CPRD) Gold database, which is linked to Hospital Episodes Statistics (HES) inpatient data, the HES Diagnostic Imaging Dataset (DID), Office for National Statistics mortality data and Index of Multiple Deprivation socio-economic status data. Women aged ≥18 years with a diagnostic SUI/POP Read code. Rates are estimated using negative binomial regression. Rates of referrals for: psychological and pain services; urinalysis, C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) testing; and pelvic ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI) scans. A cohort of 220 544 women were eligible for inclusion; 74% (n = 162 687) had SUI, 37% (n = 82 123) had POP and 11% (n = 24 266) had both. Rates of psychological referrals and CT scans were lower in women with SUI mesh surgery, but this was offset by higher rates of CRP testing in women with SUI or POP mesh, MRI scans in women with SUI mesh, and urinalysis testing and referrals to pain clinics for women with POP mesh. Our results suggest a higher burden of morbidity in women with SUI/POP mesh surgery, and that these women may require ongoing follow-up in the primary care setting.

Cosmetic and functional impact of fascia lata harvest for use in surgery for stress urinary incontinence.

There has been increased interest in using autologous tissues since the Food and Drug Administration banned transvaginal mesh for pelvic organ prolapse in 2019. Our study aims to assess patients' perspective of functional and cosmetic impact on the fascia lata harvest site in patients undergoing fascia lata harvest for the treatment of stress urinary incontinence (SUI). This is a prospective survey study of a retrospective cohort of patients who underwent a fascia lata pubovaginal sling between 2017 and 2022. Participants completed a survey regarding the functional and cosmetic outcomes of the harvest site. Seventy-two patients met the inclusion criteria. Twenty-nine patients completed the survey for a completion rate of 40.3%. For functional symptoms, 24.1% (7/29) of patients reported leg discomfort, 10.3% (3/29) reported leg weakness, 10.3% (3/29) reported a bulge, 17.2% (5/29) reported scar pain, 14.8% (4/27) reported scar numbness, and 17.2% (5/29) reported paresthesia at the scar. For cosmetic outcomes, 72.4% (21/29) reported an excellent or good scar appearance. On the PGI-I, 75.9% (22/29) reported their condition as very much better (48.3%, 14/29) or much better (27.6%, 8/29). The majority of patients reported being satisfied with the functional and cosmetic outcomes of their harvest site as well as satisfied with the improvement in their SUI. Less than 25% of patients report harvest site symptoms, including leg weakness, scar bulging, scar pain, scar numbness, or paresthesia in the scar. This is important in the context of appropriate preoperative discussion and counseling regarding fascia lata harvest.

Diagnosis and management of complications following pelvic organ prolapse surgery using a synthetic mesh: French national guidelines for clinical practice

Diagnosis and management of complications following pelvic organ prolapse surgery using a synthetic mesh: French national guidelines for clinical practice

The impact of vaginal surgical mesh devices on consultation rates by type and health care provider in UK primary care: A cohort study in the Clinical Practice Research Datalink.

To examine consultation rates by type of consultation and health care provider in women with stress urinary incontinence (SUI) and/or pelvic organ prolapse (POP), with and without surgical mesh implants. Longitudinal open cohort study from April 2006 to November 2018 in the Clinical Practice Research Datalink (CPRD). Rates of consultations with general practitioners (GPs), nurses, other clinicians and administrators by consultation type (face-to-face, telephone or administrative), and types of administrative consultations, estimated using negative binomial regression. Of 220,544 women eligible for inclusion, 74% (n=162,687) had SUI, 37% (n=82,123) had POP, and 11% (n=24,266) had both. Face-to-face consultation rates were stable over time, at about 9 per year. Administrative consultations with GPs and administrators increased between 2006 and 2018, but averaged 31 per year. After adjustment, for both SUI and POP mesh surgery, there were lower rates of face-to-face consultations with GPs, higher rates of face-to-face consultations with other clinicians, higher rates of telephone consultations with GPs and other clinicians, and higher rates of administrative consultations with GPs, nurses and administrators. The higher rate of consultations with GPs coded as administrative consisted of results recording and administrative codes, and the higher rates of consultations with administrators were coded as repeat issue, other, administration and third-party consultations. Caring for women with mesh places a higher administrative burden on GPs and administrators. There may be potential to reduce this workload through a more streamlined care pathway.

Cystoscopic removal of transvaginal mesh: Long-term outcomes.

This study's aim is to evaluate the long-term quality of life and functional outcomes following cystoscopic excision of stress urinary incontinence (SUI) and pelvic organ prolapse (POP) mesh extruded into the urinary tract in women. A retrospective chart review was performed of all cases of cystoscopic removal of extruded mesh at our high-volume tertiary care centre between April 2013 and August 2021. Postoperative patient-reported outcomes were collected via questionnaires: Urogenital Distress Inventory Short Form (UDI-6), EQ-5D-5L Visual analogue scale, ICIQ-Satisfaction (ICIQ-S) and additional questions regarding postoperative sexual function. During the study period, 27 women with a median age of 61 years (45-87) underwent cystoscopic mesh removal surgery using either Ho-YAG laser (56%) or bipolar loop resection (44%). The most common presentation of mesh extrusion was recurrent urinary tract infections (67%). Other presenting complaints were pain (41%), urinary urgency ± incontinence (41%) and voiding difficulties (18%). Long-term follow-up outcomes from 20 patients (median follow-up: 24 months) showed that mesh removal was rated successful by 80%, and 100% would choose to have the surgery again if in the same situation. Recurrent SUI was reported by 45% of respondents, and urinary urge incontinence was found in 50%. For patients who answered the sexual function questions, 50% reported improved sexual function postmesh removal (6/12). Cystoscopic removal of extruded female SUI and POP mesh is associated with high patient satisfaction and low morbidity in appropriately selected patients at 2-year median follow-up. A patient-centred shared decision-making process is essential in counselling patients regarding options and expected outcomes following mesh removal surgery.

MP07-09 TRENDS IN IMPLANTATION AND EXPLANTATION OF MESH FOR PELVIC ORGAN PROLAPSE AMONG FPMRS AND GENERAL UROLOGISTS

You have accessJournal of UrologyCME1 Apr 2023MP07-09 TRENDS IN IMPLANTATION AND EXPLANTATION OF MESH FOR PELVIC ORGAN PROLAPSE AMONG FPMRS AND GENERAL UROLOGISTS Mitchell G. Goldenberg, Unwanaobong Nseyo, Madeleine Burg, Evgeniy Kreydin, and David A. Ginsberg Mitchell G. GoldenbergMitchell G. Goldenberg More articles by this author , Unwanaobong NseyoUnwanaobong Nseyo More articles by this author , Madeleine BurgMadeleine Burg More articles by this author , Evgeniy KreydinEvgeniy Kreydin More articles by this author , and David A. GinsbergDavid A. Ginsberg More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003222.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The use of synthetic mesh in the treatment of pelvic floor conditions has long been scrutinized. Statements from multiple professional societies recommend that mesh for pelvic organ prolapse (POP) be performed only by those properly trained in both implantation and management of complications. We used case logs from the American Board of Urology (ABU) to understand temporal changes in the use of pelvic mesh among subspecialty trained and general urologists. METHODS: Case logs submitted to the ABU for certification and recertification in 2013 and in 2020 were reviewed. Demographic data including surgeon age, fellowship training, certification cycle, and practice type and location was analyzed. We analyzed trends in mesh insertion (both for POP and SUI) and mesh revision/removal based using common procedural terminology (CPT) codes among FPMRS and general urologists. Statistical analysis was performed using chi-squared test, binary regression, and Cronbach’s alpha. RESULTS: Over the two study years, 1877 surgeons contributed 253,326 unique procedures. A total of 1910 (1.8% of total cases) mesh implantation procedures were performed in 2013 compared to 2245 (1.5%) in 2020. Among FPMRS providers (n=154, 8.2%), the use of vaginal mesh for POP decreased from 4.6% to 1.5% (p<.001) of their total procedure volume, while transabdominal mesh for POP increased from 3.1% to 5.3%, (p<.001, see Figure 1). Similar changes were seen among generalists, among whom the rate tripled (0.1% to 0.4%, p<.001, see Figure 1b). Mesh revision/removal rates were stable (2.9%, p=.224) among FPMRS providers, but significantly decreased among general urologists in 2020 (0.2% to 0.1% p<.001). On multivariable analysis, generalists more likely to perform mesh revisions/removals were non-academic, female, and practiced in areas with a population density ≥1 million. Generalists implanting mesh were also more likely to perform revision/removal (Cronbach’s alpha=0.343, p=.015). CONCLUSIONS: Mesh-augmented POP repairs continue to be used among FPMRS and general urologists. However, these data indicate that general urologists may be referring mesh complications onto FPMRS providers, indicating that societal and FDA recommendations are perhaps not being adhered to. Source of Funding: The Catherine and Joseph Aresty Department of Urology © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e87 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mitchell G. Goldenberg More articles by this author Unwanaobong Nseyo More articles by this author Madeleine Burg More articles by this author Evgeniy Kreydin More articles by this author David A. Ginsberg More articles by this author Expand All Advertisement PDF downloadLoading ...

MP48-16 TRENDS IN STRESS URINARY INCONTINENCE PROCEDURES FROM 2012 TO 2020 FROM THE UDA PROJECT

You have accessJournal of UrologyCME1 Apr 2023MP48-16 TRENDS IN STRESS URINARY INCONTINENCE PROCEDURES FROM 2012 TO 2020 FROM THE UDA PROJECT John Lavelle, Chad Ellimoottil, Ziya Kirkali, Julia S. Barthold, Lei Sandy Ye, Po-Lun Chou, Zhihang Lin, Myrna Cozen, Kyle Buika, and John Hornberger John LavelleJohn Lavelle More articles by this author , Chad EllimoottilChad Ellimoottil More articles by this author , Ziya KirkaliZiya Kirkali More articles by this author , Julia S. BartholdJulia S. Barthold More articles by this author , Lei Sandy YeLei Sandy Ye More articles by this author , Po-Lun ChouPo-Lun Chou More articles by this author , Zhihang LinZhihang Lin More articles by this author , Myrna CozenMyrna Cozen More articles by this author , Kyle BuikaKyle Buika More articles by this author , and John HornbergerJohn Hornberger More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003294.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Stress urinary incontinence (SUI) is a major quality of life problem for many people. In women, SUI is associated with pelvic organ prolapse (POP) and in men after a radical prostatectomy. A safety review started in 2011 by the FDA of POP mesh resulted in the 2019 recall. This study reviews the prevalance and procedure trends for SUI between 2012 to 2020. METHODS: Using the 100% Optum® Clinformatics® Data Mart data and 100% national Medicare Fee-for-Service data, we identified subjects claims for urinary incontinence (UI) and any procedures performed for UI. Results reported as mean ± standard deviation. RESULTS: From 2012 - 2020, the mean prevalence of any UI in the 18-64 age group was 37,529 ± 3292 or 0.62% of the population. In the Medicare population (aged 65+), it was 1,439,221 ± 90507, or 5.7% of the group. The Female to Male ratio in the <65 yr group was 2.52:1 and in the 65+ was 5.31:1. The Medicare mean SUI prevalence was 212223 ± 14292 (0.84% population), and the Optum group was 13,179 ± 1,535 (0.22%).38,677 Medicare patients received procedures for UI in 2012. This increased to 54,122 by 2019, falling to 45,667 during COVID. In 2012, 12,286 patients received SUI procedures, which plateaued at 8,670/yr for 2015 to 2019. In 2020, 6508 patients had a SUI procedure. (Breakdown in Figure 1A). 4020 patients with UI aged 18-64 got a procedure in 2012, which decreased by 45% to 2635 in 2019 with a dip for COVID to 2020. The numbers plateaued from 2014 to 2019 at 2500 patients/yr approximately. The SUI patient numbers for this group decreased from 2501 in 2012 to 967 in 2020, plateaued between 2014 and 2019 at 1250 patients/yr approximately. (Breakdown in Figure 1B) There was a 50% decrease in patients getting sling procedures. Patients obtaining artificial urinary sphincter, and injectables remained constant. Men receiving artificial urinary sphincter, slings, and injectables has remained even in the 65+ age group. However, in the 18-64 age group, men obtaining slings decreased. CONCLUSIONS: The claims prevalence for UI has increased in older age and decreased in younger patients. Sling use has decreased in all female patients and younger men. The overall decrease in procedures for SUI, appears partly due to decreased reporting of incontinence claims in the younger population, together decreased Sling procedures in female patients. Source of Funding: NIDDK Contract Number GS-10F-0133S © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e661 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information John Lavelle More articles by this author Chad Ellimoottil More articles by this author Ziya Kirkali More articles by this author Julia S. Barthold More articles by this author Lei Sandy Ye More articles by this author Po-Lun Chou More articles by this author Zhihang Lin More articles by this author Myrna Cozen More articles by this author Kyle Buika More articles by this author John Hornberger More articles by this author Expand All Advertisement PDF downloadLoading ...

Polypropylene Pelvic Mesh: What Went Wrong and What Will Be of the Future?

Polypropylene (PP) pelvic mesh is a synthetic mesh made of PP polymer used to treat pelvic organ prolapse (POP). Its use has become highly controversial due to reports of serious complications. This research critically reviews the current management options for POP and PP mesh as a viable clinical application for the treatment of POP. The safety and suitability of PP material were rigorously studied and critically evaluated, with consideration to the mechanical and chemical properties of PP. We proposed the ideal properties of the 'perfect' synthetic pelvic mesh with emerging advanced materials. We performed a literature review using PubMed/Medline, Embase, Cochrane Library (Wiley) databases, and ClinicalTrials.gov databases, including the relevant keywords: pelvic organ prolapse (POP), polypropylene mesh, synthetic mesh, and mesh complications. The results of this review found that although PP is nontoxic, its physical properties demonstrate a significant mismatch between its viscoelastic properties compared to the surrounding tissue, which is a likely cause of complications. In addition, a lack of integration of PP mesh into surrounding tissue over longer periods of follow up is another risk factor for irreversible complications. PP mesh has caused a rise in reports of complications involving chronic pain and mesh exposure. This is due to the mechanical and physicochemical properties of PP mesh. As a result, PP mesh for the treatment of POP has been banned in multiple countries, currently with no alternative available. We propose the development of a pelvic mesh using advanced materials including emerging graphene-based nanocomposite materials.

Lateral suspension with V-NOTES for the treatment of pelvic organ prolapse with the Salman-KetenciGencer technique.

Pelvic organ prolapse (POP) is a common morbidity and 10-20% of the patients need surgical correction. Sacrocolpopexy or sacrohysteropexy procedures are satisfactory but still difficult. Lateral suspension (LS) as a safe and simple technique has become an alternative technique recently. Vaginal natural orifice transluminal endoscopic surgery (V-NOTES) is also a new modality and LS using V-NOTES has not been performed previously and should be promising. This prospective observational pilot study was conducted with a total of 38 women with stage 3 and 4 POP according to the Pelvic Organ Prolapse Quantification grading system (POP-Q). Lateral suspension via V-NOTES was performed with the Salman-KetenciGencer technique using a mesh for POP. The preoperative and postoperative 6-month POP-Q stages together with Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) scores were recorded and compared. Comparison of the preoperative and postoperative 6-month POP-Q stages of the patients were statistically significant except for the total vaginal length (p<0.01). Compared with the preoperative total and subscale scores of PISQ-12, the postoperative values were considerably improved (p<0.001). With the Salman-KetenciGencer technique not only good anatomical but also good functional results were obtained with V-NOTES. Surgeons may focus on uterine sparing while using the Salman-KetenciGencer technique for apical prolapse owing to the higher rate of complications related to the colposuspension and better sexual results after the cervicosuspension.

Development of a conceptual framework for a new patient-reported outcome measure for pain in women following mesh surgery for pelvic floor disorders: a qualitative study

Introduction and hypothesisThe Australasian Pelvic Floor Procedure Registry (APFPR) collects both clinical and health-related quality of life (HRQoL) data on women undergoing surgery using a prosthesis such as mesh for pelvic organ prolapse (POP) and stress urinary incontinence (SUI). The registry lacks a suitable instrument to assess pain in women following mesh surgery for SUI and POP. This qualitative study describes the views on pain following mesh surgery in women and clinicians through the development of a conceptual framework, which may inform the development of a new instrument for the APFPR.MethodsWe conducted semi-structured interviews with women following mesh surgery for POP and SUI (n=17) and clinicians (n=6) in Victoria, Australia. We sought to reveal aspects of any sort of pain after a pelvic floor procedure. Interviews covered sensation, region, continuity of pain, triggers, and the mode and method of administration for a new pain-specific patient-reported outcome measure. Data were analysed using thematic analysis.ResultsWe identified the important components of pain felt by women with POP and SUI after surgery using mesh. From the seven themes outlined, a conceptual framework was developed compiling related components of pain into six specific domains.ConclusionsThis study identifies the important components of pain felt by women following mesh surgery. It is hoped that the development of a pain-specific PROM, as supported by clinicians, will assist in the timely and appropriate diagnosis and management of POP and SUI.

Would Surgeons Opt for Polypropylene Mesh if They Hypothetically Had Stress Urinary Incontinence or Pelvic Organ Prolapse?

Mesh is routinely used to treat stress urinary incontinence (SUI) and pelvic organ prolapse (POP). However, its use remains controversial. The FDA (U.S. Food and Drug Administration) ultimately deemed mesh use for SUI and transabdominal POP repair acceptable, while cautioning against transvaginal mesh for POP repair. The objective of this study was to evaluate personal opinions regarding mesh use among clinicians who routinely treat POP and SUI if they themselves were to hypothetically have either condition. A nonvalidated survey was sent to the Society of Urodynamics, Female Pelvic Medicine, and Urogenital Reconstruction (SUFU) members, and American Urogynecologic Society (AUGS) members. The questionnaire asked participants if they were to hypothetically have SUI/POP which treatment they would elect. A total of 141 participants completed the survey (20% response rate). A significant proportion preferred synthetic mid urethral slings (MUS) for SUI (69%, p <0.001). Surgeon volume was significantly associated with MUS preference for SUI in both univariate and multivariate analyses (OR 3.21 and 3.67, p <0.003). A significant proportion of providers preferred transabdominal repair or native tissue repair for POP (27% and 34% respectively, p <0.001). Private practice was significantly associated with transvaginal mesh preference for POP in univariate analysis but not multivariate analysis (OR 3.45, p <0.04). The use of mesh for SUI and POP has been controversial, leading to the FDA, SUFU and AUGS statements on synthetic mesh use. Our study found that the majority of SUFU and AUGS members who regularly perform these surgeries prefer MUS for SUI. Preferences regarding POP treatments varied.

An Observational Study on the Efficacy and Complications of a Transvaginal Single-Incision Mesh for Pelvic Organ Prolapse

An Observational Study on the Efficacy and Complications of a Transvaginal Single-Incision Mesh for Pelvic Organ Prolapse

Predictors of Clinical Outcome in Women with Pelvic Organ Prolapse Who Underwent Transvaginal Mesh Reconstruction Surgery.

Background and Objectives: To identify the predictors of clinical outcomes in women with pelvic organ prolapse (POP) who underwent transvaginal reconstruction surgery, especially with transobturator mesh fixation or sacrospinous mesh fixation. Materials and Methods: All women with POP who underwent transvaginal reconstruction surgery, especially with transobturator mesh fixation or sacrospinous mesh fixation, were reviewed. Results: Between January 2011 and May 2019, a total of 206 consecutive women were reviewed, including 68 women receiving POP reconstruction with transobturator mesh fixation and 138 women who underwent POP reconstruction with sacrospinous mesh fixation. The least experienced surgeon (hazard ratio = 804.6) and advanced stage of cystocele (hazard ratio = 8.80) were the predictors of POP recurrence, especially those women with stage 4 of cystocele. Young age (hazard ratio = 0.94) was a predictor for mesh extrusion, especially those women with age ≤67 years. Follow-up interval (odds ratio = 1.03, p = 0.02) was also an independent predictor of mesh extrusion. High maximum flow rate (Qmax, hazard ratio = 1.03) was the sole predictor of postoperative stress urinary incontinence, especially those women with Qmax ≥19.2 mL/s. Preoperative overactive bladder syndrome (hazard ratio = 3.22) were a predictor for postoperative overactive bladder syndrome. In addition, overactive bladder syndrome rate improved after surgery in the sacrospinous group (p = 0.0001). Voiding dysfunction rates improved after surgery in both sacrospinous and transobturator groups. Conclusions: Predictors of clinical outcome in women who underwent transvaginal POP mesh reconstruction are identified. The findings can serve as a guide for preoperative consultation of similar procedures.

The Long-Term Impact of Vaginal Surgical Mesh Devices in UK Primary Care: A Cohort Study in the Clinical Practice Research Datalink.

PurposeStress urinary incontinence (SUI) and pelvic organ prolapse (POP) may be treated with surgical mesh devices; evidence of their long-term complications is lacking.Patients and MethodsRates of diagnoses of depression, anxiety or self-harm (composite measure) and sexual dysfunction, and rates of prescriptions for antibiotics and opioids were estimated in women with and without mesh surgery, with a diagnostic SUI/POP code, registered in the Clinical Practice Research Datalink (CPRD) gold database.ResultsThere were 220,544 women eligible for inclusion; 74% (n = 162,687) had SUI, 37% (n = 82,123) had POP, and 11% (n = 24,266) had both. Women undergoing mesh surgery for SUI or POP had about 1.1 times higher rates of antibiotic use. Women with no previous history of the outcome, who underwent mesh surgery had 2.43 (95% CI 2.19–2.70) and 1.47 (95% CI 1.19–1.81) times higher rates of depression, anxiety, or self-harm, 1.88 (95% CI 1.50–2.36) and 1.64 (95% CI 1.02–2.63) times higher rates of sexual dysfunction and 1.40 (95% CI 1.26–1.56) and 1.23 (95% CI 1.01–1.49) times higher opioid use for SUI and POP, respectively. Women with a history of depression, anxiety and self-harm had 0.3 times lower rates of these outcomes with SUI or POP mesh surgery (HR for SUI 0.70 (95% CI 0.67-0.73), HR for POP 0.72 (95% CI 0.65-0.79)). Women with a history of opioid use who had POP mesh surgery had about 0.09 times lower rates (HR 0.91 (95% CI 0.86–0.96)) of prescriptions. Negative control outcome analyses showed no evidence of an association between asthma consultations and mesh surgery in women with POP, but the rate was 0.09 times lower (HR 0.91 (95% CI 0.87–0.94)) in women with SUI mesh surgery, suggesting that study results are subject to some residual confounding.ConclusionMesh surgery was associated with poor mental and sexual health outcomes, alongside increased opioid and antibiotic use, in women with no history of these outcomes and improved mental health, and lower opioid use, in women with a previous history of these outcomes. Although our results suggest an influence of residual confounding, careful consideration of the benefits and risk of mesh surgery for women with SUI or POP on an individual basis is required.

Beware of preoperative pain before implanting a mesh in pelvic floor reconstructive surgery.

We congratulate the authors for this large prospective longitudinal study of women with urogynaecologic mesh complications. The majority of patients (89%) had their index mesh surgery elsewhere and were later referred for management of a complication. The index surgery was mid-urethral sling (64.2%), abdominal or vaginal mesh for pelvic organ prolapse (31.2%) or both (4.6%). The study showed that patients with pain had more severe symptoms, lower quality of life, higher functional impact and less improvement in these domains after mesh removal compared to patients with mesh exposure. Even with complete mesh excision, only a third of women with pain complications reported improved symptoms after mesh removal.

Ultrasound evaluation of anterior transvaginal mesh for pelvic organ prolapse: correlation to 5-year clinical outcomes

Introduction and hypothesisVaginal prolapse mesh may effectively restore vaginal anatomy. The aim of this study was to investigate how the in vivo mesh position correlates to clinical outcomes.MethodsSeventy-one women operated on using Uphold mesh for apical pelvic organ prolapse (POP-Q, C ≥ stage II) were examined 5 years after surgery by introital-perineal 2D ultrasound in a midsagittal plane at rest and Valsalva. The horizontal line and pubis symphysis were considered the reference for all measures. Ultrasound measures were statistically compared to clinical outcomes: POP-Q, Pelvic Floor Distress Inventory (PFDI-20) and subscales [Pelvic Organ Distress Inventory (PODI-6), and Urinary Distress Inventory (UDI-6)] and the VAS scale for pain.ResultsOriginal mesh length was preserved by 86% and correlated to improved pain as estimated by VAS scale (r 0.321). Valsalva was associated with a lowering of the superior and inferior mesh margins by 7.3 and 6.1 mm, respectively (p < 0.001) but a reduction of total mesh length by only 1 mm (30.2 ± 5.2 to 29.2 ± 4.7 mm, p < 0.001). Mobility of the anterior vaginal wall (bladder neck and midurethra) at Valsalva was parallel to downward movement of the mesh inferior margin (r 0.346 and 0.314) but inversely correlated to total UDI-6 (r − 0.254 and − 0.263). Mobility of the midurethra was inversely correlated to bladder emptying (PFDI-20 Question 19, r − 0.245).ConclusionsFive years after surgery, preserved original length of the mesh with apical support was correlated to improved anatomical and patient-reported outcomes. Mesh support to the vaginal apex was associated with improved bladder emptying and total urinary distress outcomes but not stress urinary incontinence.

Evaluation of the histological and biomechanical properties of poly-4-hydroxybutyrate scaffold for pelvic organ prolapse, compared with polypropylene mesh in a rabbit model.

Poly-4-hydroxybutyrate (P4HB) is a biopolymer produced by Escherichia coli K12 bacteria. P4HB is fully resorbed in vivo by 18-24months post-implantation. The aim of this study is to evaluate P4HB in the rabbit abdomen and vagina to determine that the biomechanical and histological properties are similar to the standard polypropylene mesh. Our hypothesis is that the histological and biomechanical properties of a fully absorbable graft will be similar to a lightweight polypropylene (PP) mesh when implanted in rabbit vagina and abdomen. Sixteen (n = 16) female New Zealand White (retired breeder) rabbits were equally divided between two time points (3 and 9months). A total of 17 rabbits were used owing to one death secondary to suspected cardiomyopathy. P4HB scaffold and PP mesh were subcutaneously and peri-vaginally implanted into the rabbit abdomen and vagina respectively. All rabbits had both posterior and anterior vaginal implants, and half of the rabbits had four abdominal implants in addition to the vaginal implants. The abdominal implants were 4.5cm long × 1.5cm wide whereas the vaginal implants were 1.5cm long × 0.5cm wide. At 3 and 9months, gross necropsy was performed and samples were obtained, sectioned, stained and evaluated via histological analysis. Specimens were assessed for host inflammatory response, neovascularization, elastin content, and collagen deposition/maturation. Specimens were also biomechanically evaluated via uniaxial tensile test to determine the stiffness, ultimate tensile strength and load at ultimate tensile strength of the device/tissue composite. No abdominal mesh exposures were noted. A comparable number of asymptomatic partial vaginal exposures were observed at 3months (P4HB: n = 3; PP: n = 2) and 9months (P4HB: n = 3; PP: n = 2) respectively. Histological analysis of specimens showed comparable results in the P4HB and PP groups at 3 and 9months post-implantation. Although no acute inflammation was seen, chronic inflammation was demonstrated in all specimens. Elastic fibers were present in the 3-month vaginal PP and P4HB specimens, but were not seen again. There was an increase in type I/III collagen noted over time. Biomechanical evaluation of the vaginal mesh tissue complex showed ultimate tensile strength was not significantly different between P4HB and PP groups at 3 (P = 0.625) and 9months (P = 0.250) respectively. P4HB scaffold may represent a fully absorbable alternative to permanent mesh for pelvic organ prolapse (POP) repair.

Preliminary evaluation of the short-term outcomes of polytetrafluoroethylene mesh for pelvic organ prolapse.

Tension-free vaginal mesh (TVM) surgery using synthetic polypropylene (PP) soft mesh had spread rapidly. However, the frequency of mesh-related postoperative complications had increased, and PP was banned in April 2019. In Japan, however, transvaginal surgery using polytetrafluoroethylene (PTFE) mesh had been approved. In this study, we evaluated the clinical outcome and quality of life (QOL) of the postoperative course using PP mesh and PTFE mesh (named "ORIHIME™" ) in a combination surgery for utero-sacral ligament suspension and anterior vaginal support using anterior TVM. The vaginal hysterectomy and utero-sacral ligament colpopexy augmented by anterior vaginal mesh implants using PP mesh and PTFE mesh were performed on patients with stage III to IV cystocele and uterine prolapse. The clinical outcome and QOL changes in their postoperative course were evaluated by comparing 15 cases of PP mesh and 13 cases of PTFE mesh. There was no difference between the PP group and PTFE group in characteristics. No mesh-related complications occurred during the follow-up period. With regard to the pelvic organ prolapse quantification (POP-Q) score, no significant difference was found between the two groups. Comparing the postoperative QOL of both groups, the PTFE group had significantly higher values in two domains than PP group (SF-12v2 questionnaire). We used the world's first PTFE mesh to compare PP mesh with postoperative POP-Q and QOL after the same surgery, with the same operator, and at the same institution. The results showed no significant difference between both mesh materials in the short-term.