Vaginal Mesh Surgery Research Articles

Vaginal Mesh for Urinary Incontinence and Prolapse: Impact on Sexual Function

The evolution of vaginal mesh has had a large positive impact on quality of life for patients with stress incontinence and pelvic organ prolapse; for instance, the mid-urethral sling is considered the gold standard treatment for stress incontinence. There are unique side effects, however, for the use of mesh in surgical implantation, including infection, erosion, extrusion, and changes in urinary habits as well. A side effect that may be overlooked in these women undergoing vaginal mesh surgery is sexual dysfunction; while the surgery itself may strongly improve quality of life, there can be some detrimental sexual side effects that may hinder the patient’s quality of life or sexual function overall. Changes in sexual function can be encountered in anywhere from 5 to 20% of all women undergoing surgery for stress incontinence or vaginal prolapse, and the scope of these changes vary from positive to negative. These changes can be broken down by sub-topics explored in the FSFI including dyspareunia or pain, overall function, lubrication, and orgasm. Sexual function is an often overlooked and underdiscussed topic in the medical field and between clinicians and patients overall. It is imperative that clinicians discuss any and all possible complications of mesh surgery with patients preoperatively, including any effects, both positive and negative, in regard to sexual function.

Re: Patient Safety in Vaginal Mesh Surgery

Re: Patient Safety in Vaginal Mesh Surgery

Long-term follow-up of patients treated by transvaginal mesh repair for anterior prolapse

ObjectiveThe aim of the study was to assess 5 years outcome of transvaginal single incision mesh surgery (SIMS) for anterior pelvic organ prolapse (POP). Study designThis was a prospective study including all patients from January 2009 to December 2012 who underwent SIMS for symptomatic anterior prolapse stage ≥2, according to POP Quantification (POP-Q). Symptoms and quality of life were assessed using validated questionnaires: Pelvic Floor Distress Inventory (PFDI-20), Pelvic Floor Impact questionnaire (PFIQ-7), and Prolapse/ Incontinence Sexual Questionnaire (PISQ-12). Main outcome was subjective success (question 3 of PFDI-20 score = 0). Mesh-related complications, objective and functional outcomes were used as the secondary outcomes. Results270 patients were included in the study. Median follow-up was 5,7 years [4,5–8,2]. Subjective success rate was 86,6% at 5 years. Objective success rate was 53,1% at 5 years. At 5 years, composite failure (subjective + objective) occurred for 17 patients (12%), 7 patients with direct recurrence and 10 with indirect recurrence. Re-treatment was performed in six patients (2,8%; 3 hysterectomies for apical recurrence and 3 posterior repairs for posterior recurrence). One case (0,4%) of asymptomatic mesh exposure occurred. The reoperation rate for mesh-related complications was 3,4%. At 5 years, de novo dyspareunia rate was 11,7%, 3,9% considered as mesh-related. A significant improvement was noted for symptoms and quality of life. ConclusionFive-year results demonstrate that vaginal mesh surgery provides a durable and safe repair of anterior compartment prolapse with a low rate of mesh-related complications and reoperations. Between the 2- and 5-year follow-up, patient satisfaction and associated improvements in prolapse-specific symptoms were sustained and minimal new morbidity occurred.

What you need to know about vaginal mesh surgery

What you need to know about vaginal mesh surgery

The Disability Impact and Associated Cost per Disability in Women Who Underwent Surgical Revision of Transvaginal Mesh Kits for Prolapse Repair.

The aim of this study was to investigate disability impact in patients and cost to the families of patients who have had complications of transvaginal prolapse mesh kits and underwent surgical revision. Patients who developed complications of transvaginal mesh kits for prolapse and who had undergone vaginal prolapse mesh surgical revision/removal in 2009 to 2014 at a single institution were identified by Current Procedural Terminology codes. The group was invited to complete a phone survey pertaining to the initial vaginal mesh used for prolapse surgery utilizing Sheehan Disability Scale (scale 0-10) and Years of life Lived with Disability (YLDs) questionnaires. The data collected were used to estimate the disability and cost analysis. We used our data to estimate the economic and quality-of-life impact of vaginal mesh complications on patients in the United States RESULTS: Sixty-two patients (62/198 [31.2%]) were consented to participate and completed the questionnaires by phone. Extremely disabled patients were 18 (29%) of 62 of whole cases, and 5 (8%) of 62 reported that they had no disability after vaginal mesh surgery. The median for overall disability score after vaginal mesh procedure was 8 (which reflects marked disability on a scale of 0-10). The majority of patients missed a median of 12 months of their school or work because of their mesh complications. Thirty-seven (59.6%) of 62 did not improve after mesh removal. Twenty-one (33.9%) of 62 stated that their family income dropped because of productivity loss related to mesh complications. The mean time between vaginal mesh surgery and mesh removal procedure was 4.7 years. Sheehan Disability Scale scores are significantly correlated with YLDs outcomes. Patients' overall disability score showed a significant correlation with YLDs scores (P < 0.0001). Vaginal mesh for prolapse reduction complications had a sustained disability impact that continued despite mesh removal. Likewise, the complications were associated with increased economic burden on the families of the effected individuals and a drop in the family income in more than one third of the families.

Comparison between tension-free vaginal tape and transobturator tape in treating stress urinary incontinence after vaginal mesh surgery

ObjectiveA midurethral sling is the gold standard surgical treatment for stress urinary incontinence (SUI), however a lower success rate has been reported in the treatment of SUI after pelvic organ prolapse surgery. The aim of this study was to compare the success rates, quality of life, and complications with treatment using tension-free vaginal tape (TVT) and transobturator tape (TOT) in these patients. Materials and MethodsWe enrolled patients who had symptomatic SUI after anterior vaginal mesh repair who underwent either TVT or TOT surgery. Successfully cure was defined as the absence of urinary leakage in a stress test during filling cystometry, and a negative cough test. Quality of life was evaluated using the short form of the Urinary Distress Inventory (UDI-6) and Incontinence Impact Questionnaire (IIQ-7). ResultsWe included 50 patients in the TOT group and 37 patients in the TVT group, with a median follow-up of 18.5 months. The TVT group had a significantly higher success rate than the TOT group (88% vs. 60%, p = 0.036), while there was no statistically significant difference in de novo detrusor overactivity (30% vs. 9%, p = 0.090). There was also no significant difference in postoperative quality of life (UDI-6, 5.9 ± 7.9 vs. 5.0 ± 5.9, p = 0.639; IIQ-7, 5.2 ± 12.5 vs. 4.3 ± 9.7, p = 0.766). The TVT group had a longer operative time (p < 0.001) and hospital stay (p = 0.004), however the TOT group required more repeat surgeries for recurrent SUI (p = 0.045). ConclusionRetropubic TVT is a more effective surgical option than TOT in women with SUI after vaginal mesh repair.

Effects of mesh-related complications in vaginal surgery on quality of life

Introduction and hypothesisVaginal mesh surgery is subject of debate due to the impact of mesh-related complications on patient’s lives. Not all of these complications are symptomatic. Restoration of the anatomy and improvement of pelvic floor function as a result may counter the experienced discomfort related to adverse events. We hypothesized that health-related quality of life (HR-QoL) is comparable in women after vaginal mesh surgery regardless of the presence or absence of a mesh-specific complication.MethodsThis was a cross-sectional study of 128 women who had vaginal mesh surgery in a Dutch university hospital between 2007 and 2012. HR-QoL was measured in women with and without mesh complications using standardized QoL questionnaires Urogenital Distress Inventory-6 (UDI-6), Incontinence Impact Questionnaire (IIQ), Defecation Distress Inventory (DDI), and Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire (PISQ-12). Complications were scored according to the International Urogynecological Association (IUGA) complication classification. Comparisons between groups were performed with Student’s t test and analysis of variance (ANOVA) test.ResultsIn 29 (23%) women, a mesh-related complication occurred. The domain scores of the UDI-6, DDI, IIQ, and PISQ showed no statistically significant differences between women with and without a mesh-related complication. A post hoc analysis showed similar HR-QoL for those in whom the complication had been resolved and those with persistent symptoms of the complication.ConclusionMesh surgery imposes specific complications. When counseling patients about the potential adverse events related to vaginal mesh surgery, it is important to inform them that mesh-related complications do not negatively affect QoL related to micturition, defecation, and sexual functioning.

Do urodynamic findings influence the approach to mid-urethral sling surgery for stress urinary incontinence?

Recent press coverage on vaginal mesh surgery has resulted in a change in how patients are counselled, managed and treated in the UK. For stress urinary incontinence surgical procedures such as insertion of tension-free vaginal tape are commonplace and generally performed as a day-case procedure. Effective and successful management of female urinary incontinence is difficult, even when using diagnostic testing where all conservative managements have failed, and this indicates a need to investigate further. Specialist texts in the fields of urology and urogynaecology argue that urodynamics can help inform the success of surgical intervention for stress urinary incontinence. The aim of this review was to look for evidence of practice where urodynamic findings are used to determine the successful outcome of mid-urethral sling surgery in females. A literature search to identify research on this topic was performed with appraisal of qualifying literature. The qualifying research included attitudes towards urodynamic studies among urogynaecologists and urologists, demonstration that urodynamics has been proven to influence changes in diagnosis and surgical approaches, and the capacity for urodynamics to predict successful outcomes in mid-urethral sling surgery. Analysis of the literature found no evidence to suggest that urodynamic findings can be used to determine successful outcomes following mid-urethral sling surgery.

V10-08 ADJUSTABLE RETROPUBIC SLING FOR SURGICAL TREATMENT OF STRESS URINARY INCONTINENCE IN COMPLICATED CASES

You have accessJournal of UrologyFemale Pelvic Medicine1 Apr 2018V10-08 ADJUSTABLE RETROPUBIC SLING FOR SURGICAL TREATMENT OF STRESS URINARY INCONTINENCE IN COMPLICATED CASES Dmitry Shkarupa, Nikita Kubin, Olga Staroseltseva, Ekaterina Shapovalova, and Anastasia Zaytseva Dmitry ShkarupaDmitry Shkarupa More articles by this author , Nikita KubinNikita Kubin More articles by this author , Olga StaroseltsevaOlga Staroseltseva More articles by this author , Ekaterina ShapovalovaEkaterina Shapovalova More articles by this author , and Anastasia ZaytsevaAnastasia Zaytseva More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2664AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Midurethral sling is a standard primary surgical procedure for female stress urinary incontinence (SUI). Retropubic (RP) sling shows higher effectiveness than transobturator (TO) in patients with recurrent SUI. At the time, bladder outlet obstruction (BOO) is a common complication of RP sling. The purpose of the study was to evaluate the effectiveness and safety of retropubic adjustable sling in patients with complicated SUI. METHODS Our study comprised 43 women suffering from SUI and who had one or more predictors of surgical failure such as previous anti-incontinence surgery or pelvic organ prolapse repair, intrinsic sphincter deficiency, severe SUI and concomitant morbidity. All patients underwent RP adjustable sling insertion. We used monofilament polypropylene sling with special threads, which allow to tune its tension during 2 days after surgery. The pre- and postoperative evaluation included urogynecological history, vaginal examination, cough stress test (CST), urodynamic study, bladder ultrasound and post-void residual urine volume (PVR) measurement, 1-hour Pad-test, questionnaires (UDI-6, UIQ-6, PFIQ-7, ICIQ-SF). RESULTS Mean surgery time was 27,5±10,1 min. There were no cases of intraoperative bladder injury or clinically significant bleeding. The next day after surgery 25 patients (51,8%) required tension adjustment. The tension was increased in 14 (32,5%) patients presented with positive CST and decreased in 11 (25,6%) patients, who had obstructive flow pattern, complaints of a slow or intermittent stream and PVR>100 ml. This procedure was repeated in 7 (16,3%) because of positive CST at the following examination. After adjustment, all patients were continent, with PVR≤ 60 ml. There were no cases of BOO or urinary retention after tension adjustment. None of the patients required intermittent or indwelling catheterization. Mean follow-up was 8.8±4.4 months.The objective cure rate was 95,4% (n=41). There was no significant decrease of Qmax (p>0,05). We had 3 (6,9%) cases of vaginal mesh extrusion in patients who had a history of vaginal mesh surgery. None of them underwent tension adjustment. There were no cases of wound infections, chronic pain or dyspareunia and no cases of BOO during follow-up. The questionnaires scores showed 88,3% (n=38) patients to be very satisfied with great improvement of the quality of life (p<0,001). CONCLUSIONS The adjustable retropubic sling is a good option for treating patients with risk factors of failure. It provides high objective and subjective cure rate and low complication number. At the same time, it allows to minimize the risk of postoperative voiding dysfunction © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e1075 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Dmitry Shkarupa More articles by this author Nikita Kubin More articles by this author Olga Staroseltseva More articles by this author Ekaterina Shapovalova More articles by this author Anastasia Zaytseva More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Risk factors for surgical site infection after transvaginal mesh placement in a nationwide Japanese cohort.

We conducted a nationwide survey on perioperative management and antimicrobial prophylaxis of transvaginal mesh surgeries for pelvic organ prolapse in Japan to understand the practice and risk factors for surgical site infection (SSI). Health records of women undergoing tension-free vaginal mesh (TVM) surgeries from 2010 to 2012 were obtained from 135 medical centers belonging to the Japanese Society of Pelvic Organ Prolapse Surgery. The questionnaire addressed hospital volume, perioperative management, and SSI. Risk factors for SSI were investigated by comparing cases with and without SSI. The hospital volume among institutions varied from 0 to 248 per year (median 16.7). Preoperative hair removal, bowel preparation, and urine culture were routinely performed at 74 (55%), 66 (49%), and 24 (18%) hospitals, respectively. Prophylactic antimicrobials used were mostly first-generation (43%) or second-generation (42%) cephalosporin. SSI was reported in 86 of 9323 patients (0.92%). A multivariate analysis indicated lower hospital volume (odds ratio [OR], 0.995 [by 1-point increase]; P < 0.001), preoperative bowel preparation (OR, 2.08; P = 0.013), non-routine urine culture (OR, 3.00; P = 0.0006), and the use of antibiotics other than first-generation cephalosporin (OR, 5.29; P = 0.0011) as significant risk factors for SSI. In contrast, the cut-off points of hospital volume for preventing SSI was 116.7 cases (area under curve: 0.61). The prevalence of SSI in TVM surgeries was 0.92% in Japan. Lower hospital volume, bowel preparation, non-routine preoperative urine culture, and prophylactic antibiotics other than first-generation cephalosporin significantly elevated the incidence of SSI.

Vaginal mesh operations in the urogynecological practice after the FDA warnings. Use or not to use mesh?

The prevalence of pelvic organ prolapse (POP) with aging is escalating alarmingly, and now becoming a growing epidemic among the elderly. Synthetic transvaginal mesh (TVM) has been employed with increasing popularity in the treatment of POP until the end of the last decade. After the U.S. Drug and Food Administration (FDA) warnings in the years 2008 and 2011, the number of vaginal mesh operations has decreased dramatically. The aim of the study was to evaluate and compare the anti-POP effectivity, the anti-stress incontinence (anti-SUI) efficacy, and the late (36 months) post-operative complications of the anterior vaginoplasty and the TVM operations. We analysed the clinical data from 120 patients with stage II-III anterior prolapse and concomitant SUI who had undergone surgery at a tertiary referral centre in Hungary between January 2013 and January 2014. Sixty patients underwent Kelly-Stoeckel vaginoplasty and the other 60 cases had TVM operation. The surgical complications were classified using the Clavien-Dindo (CD) classification system. The anti-POP (91.6% vs. 63.3%; p<0.001) and the anti-SUI efficacy (90% vs. 55%, p<0.001) were significantly higher in the TVM group than in the vaginoplasty group, while the overall extrusion rate was found 8.3% after a 3-year follow-up. The Clavien-Dindo score (CD) proved that the early post-operative complication profile was similar among the TVM patients as compared to the vaginoplasty group (p = 0.405). Vaginal mesh surgery represents an effective procedure for prolapse and concomitant SUI with a decreased risk of short- and long-term complications. Orv Hetil. 2018; 159(10): 397-404.

Safety of Vaginal Mesh Surgery Versus Laparoscopic Mesh Sacropexy for Cystocele Repair: Results of the Prosthetic Pelvic Floor Repair Randomized Controlled Trial

BackgroundLaparoscopic mesh sacropexy (LS) or transvaginal mesh repair (TVM) are surgical techniques used to treat cystoceles. Health authorities have highlighted the need for comparative studies to evaluate the safety of surgeries with meshes. ObjectiveTo compare the rate of complications, and functional and anatomical outcomes between LS and TVM. Design, setting, and participantsMulticenter randomized controlled trial from October 2012 to April 2014 in 11 French public hospitals. Women with cystocele stage ≥2 (pelvic organ prolapse quantification), aged 45–75 yr, without previous prolapse surgery. InterventionSynthetic nonabsorbable mesh placed in the vesicovaginal space, sutured to the promontory (LS) or maintained by arms through pelvic ligaments (TVM). Outcome measurements and statistical analysisRate of surgical complications ≥grade II according to the modified Clavien–Dindo classification at 1 yr. Secondary outcomes were reintervention rate, and functional and anatomical results. Results and limitationsA total of 130 women were randomized in LS and 132 in TVM; five women withdrew before intervention, leaving 129 in LS and 128 in TVM. The rate of complications ≥grade II was lower after LS than after TVM, but did not meet statistical significance (17% vs 26%, treatment difference 8.6% [95% confidence interval, CI −1.5 to 18]; p=0.088). The rate of complications of grade III or higher was nonetheless significantly lower after LS (LS=0.8%, TVM=9.4%, treatment difference 8.6% [95% CI 3.4%; 15%]; p=0.001). LS was converted to TVM in 6.3%. The total reoperation rate was lower after LS but did not meet statistical significance (LS=4.7%, TVM=10.9%, treatment difference 6.3% [95% CI −0.4 to 13.3]; p=0.060). There was no difference in symptoms, quality of life, improvement, composite definition of success, anatomical results rates between groups except for the vaginal apex and length, and dyspareunia (in favor of LS). ConclusionsLS is a valuable option for primary repair of cystocele in sexually active patients. LS is safer than TVM, but may not be feasible in all cases. Both techniques offer same functional outcomes, success rates, and anatomical outcomes, but sexual function is better preserved by LS. Patient summaryOur study demonstrates that laparoscopic sacropexy (LS) is a valuable option for primary repair of cystocele. LS offers equivalent success rates to vaginal mesh procedures, but is safer with a lower rate of complications and reoperations, and sexual function is better preserved.

A long-term cohort study of surgery for recurrent prolapse comparing mesh augmented anterior repairs to anterior colporrhaphy

BackgroundThere are safety concerns regarding the use of mesh in vaginal surgery with a call for long-term follow-up data. This study was designed to evaluate the long-term safety and efficacy of vaginal repairs performed for recurrent cystocele using Perigee (non-absorbable trans-obturator) mesh.MethodsA retrospective consecutive cohort of 48 women who underwent surgery for recurrent prolapse between March 2007 and December 2011 in a single centre was reviewed. Satisfaction was assessed using the patient global impression of improvement (PGI-I). Symptoms were assessed with the pelvic floor distress inventory (PFDI). Women were questioned regarding pain, sexual activity and pelvic floor surgery performed since the original procedure and examined for erosion. Women were compared to 25 controls from a consecutive cohort of repeat anterior colporrhapies.ResultsThe mean length of follow-up was 6.5 years (78 months; range 48–106). Significantly more women in the mesh group reported that they were “much better” or “very much better” (69 vs 40% p = 0.02). The rate of mesh erosion at follow-up was 11.6%. Two women in the mesh group required surgical excision of eroded mesh in the operating room (4%). The reoperation rate for a combination of de novo stress incontinence, recurrent prolapse and mesh exposure was similar in each group (33% mesh vs 32% native tissue).ConclusionsA vaginal mesh repair using a non-absorbable trans-obturator mesh has improved satisfaction compared to an anterior colporrhaphy.

Comparison of Postoperative Short-Term Outcomes between Tension-Free Vaginal Mesh Surgery Using the Capio™ SLIM Suture Capturing Device and Conventional TVM Surgery for Pelvic Organ Prolapse.

Aim We compared the short-term effectiveness of tension-free vaginal mesh (TVM) surgery using the Capio SLIM suture capturing device and conventional TVM surgery for treatment of pelvic organ prolapse. Methods We retrospectively compared postoperative pain, urinary function, and length of hospital stay between 7 patients who underwent TVM surgery using the Capio device and 9 patients who underwent conventional TVM surgery. Results There was no significant between-group difference in mean age between the Capio TVM group and the conventional TVM group (76.0 ± 5.6 years and 72.5 ± 11.5 years) or in mean operating time (86.56 ± 23.33 min and 95.28 ± 23.88 min). Four of the 7 patients in the Capio TVM group could not sense the urge to urinate after removal of the urethral catheter, but all patients in the conventional TVM group did so. The volume of the first voluntary urination was significantly smaller in the Capio TVM group than that in the conventional TVM group (102.14 ± 80.57 mL versus 472.22 ± 459.43 mL). The mean residual urine volume after the first voluntary urination was greater in the Capio TVM group than that in the conventional TVM group (285.70 ± 233.82 mL versus 34.56 ± 73.31 mL). The number of catheter days and mean maximal volume of residual urine were significantly greater in the Capio TVM group. The mean postoperative hospital stay was 6.57 ± 1.83 days in the Capio TVM group and 3.2 ± 0.42 days in the conventional TVM group. Six patients who underwent Capio TVM surgery complained of deep-seated pain in the hip region. Conclusion Urinary function may worsen postoperatively when the Capio TVM device is used in patients with pelvic organ prolapse.

Sexual function and vaginal surgery

Urinary incontinence and pelvic organ prolapse are common problems in elderly women. Corrective surgery for pelvic organ prolapse and stress urinary incontinence are performed through multiple surgical approaches, using native tissues, alloplastic implants or biological grafts. Female sexual dysfunction is a multifactorial problem and involves physical, social, and psychological dimensions. Pelvic organ prolapse and stress urinary incontinence had been asociated with female sexual dysfunction. The aim of our study was to investigate the effect of vaginal surgery on sexual function. We conducted a literature review and selected representative studies that assessed sexual function following vaginal surgery. Vaginal mesh surgery for pelvic organ prolapse and stress urinary incontinence successfully restores the anatomy, but individual domains of sexual function sometimes may be impaired. Study results are contradictory, therefore further research are required in order to determine vaginal surgery impact on sexual function.

Severe Pelvic Organ Prolapse with Large Vaginal Mucosal Defect Underwent Laparoscopic Shull’s Uterosacral Ligament Colpo-Suspension and TVM Operation by Two Stage Surgery

A 75-year-old woman complained of anuria and a sense of discomfort with severe pelvic organ prolapse (POP). We planned tension-free vaginal mesh (TVM) surgery after curing mucosal defects and completing treatment for diabetes mellitus. Anuria and pyelonephritis relapsed repeatedly due to the failure of ring pessary therapy. Surgical treatment was required emergently. We performed a total laparoscopic hysterectomy and uterosacral ligament colpo-suspension (Shull’s method). Although the vaginal apex was supported to a good position, cystocele occurred six months after the initial surgery. A TVM procedure for recurrent cystocele was performed after curing the mucosal defects, and after the improvement of glycemic control. Transvaginal native tissue repair has the advantages of low risk of ureter injury, firm colpo-suspension, and no need for mesh usage. On the other hand, it is not good at treating cystocele. Transvaginal native tissue repair should prove to be a useful surgical option for apical support without mesh.

Ultrasound Dynamics of Combined Mid-Urethral Slings and Anterior Vaginal Mesh Surgery on Severe Symptomatic Pelvic Organ Prolapse

Ultrasound Dynamics of Combined Mid-Urethral Slings and Anterior Vaginal Mesh Surgery on Severe Symptomatic Pelvic Organ Prolapse

Reviewing Patients Following Mesh Repair; The Benefits

Background/Aims: The use of synthetic mesh implants for vaginal prolapse surgery is still a subject of debate due to safety concerns. We aimed to explore long-term complications of all women treated with mesh surgery for pelvic organ prolapse (POP) in our centre. Methods: This is a cross-sectional study of 188 women who underwent vaginal mesh surgery in a Dutch University Hospital between 2007 and 2012. The prevalence of mesh exposure, pain symptoms and patient satisfaction has been documented. Results: Vaginal mesh surgery was performed in 188 women - in 147 (78%) because of recurrent POP. After a median follow-up of 40 months (range 12-76 months), 11 women (6%) had a symptomatic exposure of whom 8 women underwent surgery. Nine women (5%) had de novo pain following mesh surgery and in 3 women, (2%) this symptom was persistent despite treatment. Eighty-six percent of the responders were satisfied about their treatment. Conclusion: With this study, we showed that performing a total mesh recall is feasible. The prevalence of persisting symptomatic exposure and persisting pain symptoms was low in our population. Most of the complications we found were treatable. This is also reflected in the high overall satisfaction rate.

Association of urodynamics and lower urogenital tract nerve growth factor after synthetic vaginal mesh implantation on a rat model.

By investigating the association of urodynamics and urogenital nerve growth factor (NGF) levels in vaginal mesh surgery, we may be able to associate the likelihood of postoperative lower urinary tract symptoms developing as a result of synthetic mesh implanted for pelvic floor reconstructive surgery. Thirty-eight female Sprague-Dawley rats were divided into three groups: mesh, sham (no mesh), and control. Urodynamic study and NGF analysis of the urogenital tissues were done and results were compared among all groups. The urodynamic studies of the mesh and sham groups were further divided into the 4th and 10th days. A P-value<0.05 was considered statistically significant. All rats survived and no complications were observed during the post-implantation period. Histological evaluation showed intense acute inflammatory reaction on days 4 and 7 in the mesh and sham groups when compared to the control. The mesh group showed a larger area of inflammation as compared to the sham. The NGF levels increased significantly in the mesh and sham groups on the 4th and 10th days when compared to the control (P < 0.001, P < 0.001, respectively). Both the mesh and sham groups had shorter voiding interval and lower voiding volume on days 4 and 10 when compared to the control group (P<0.001, P<0.001, respectively). The magnitude on increasing NGF level and decreasing voiding interval and voiding volume was significantly more on the mesh group than the sham group. A higher level of NGF in the early days post-transvaginal mesh implantation is associated with a shorter voiding interval and a smaller bladder capacity, which represents abnormal lower urinary tract symptoms following transvaginal mesh implantation.

Mesh Surgery for Anterior Vaginal Wall Prolapse: A Meta-analysis.

Purpose Pelvic organ prolapse (POP) is a major health issue worldwide, affecting 6-8% of women. The most affected site is the anterior vaginal wall. Multiple procedures and surgical techniques have been used, with or without the use of vaginal meshes, due to common treatment failure, reoperations, and complication rates in some studies. Methods Systematic review of the literature and meta-analysis regarding the use of vaginal mesh in anterior vaginal wall prolapse was performed. A total of 115 papers were retrieved after using the medical subject headings (MESH) terms: 'anterior pelvic organ prolapse OR cystocele AND surgery AND (mesh or colporrhaphy)' in the PubMed database. Exclusion criteria were: follow-up shorter than 1 year, use of biological or absorbable meshes, and inclusion of other vaginal wall prolapses. Studies were put in a data chart by two independent editors; results found in at least two studies were grouped for analysis. Results After the review of the titles by two independent editors, 70 studies were discarded, and after abstract assessment, 18 trials were eligible for full text screening. For final screening and meta-analysis, after applying the Jadad score (> 2), 12 studies were included. Objective cure was greater in the mesh surgery group (odds ratio [OR] = 1,28 [1,07-1,53]), which also had greater blood loss (mean deviation [MD] = 45,98 [9,72-82,25]), longer surgery time (MD = 15,08 [0,48-29,67]), but less prolapse recurrence (OR = 0,22 [01,3-0,38]). Dyspareunia, symptom resolution and reoperation rates were not statistically different between groups. Quality of life (QOL) assessment through the pelvic organ prolapse/urinary incontinence sexual questionnaire (PISQ-12), the pelvic floor distress inventory (PFDI-20), the pelvic floor impact questionnaire (PFIQ-7), and the perceived quality of life scale (PQOL) was not significantly different. Conclusions Anterior vaginal prolapse mesh surgery has greater anatomic cure rates and less recurrence, although there were no differences regarding subjective cure, reoperation rates and quality of life. Furthermore, mesh surgery was associated with longer surgical time and greater blood loss. Mesh use should be individualized, considering prior history and risk factors for recurrence.