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Evaluation and management of complications from synthetic mesh after pelvic reconstructive surgery: a multicenter study.

Abstract：

OBJECTIVE:The purpose of this study was to describe the evaluation and management of synthetic mesh-related complications after surgery for stress urinary incontinence (SUI) and/or pelvic organ prolapse (POP). STUDY DESIGN:We conducted a multicenter, retrospective analysis of women who attended 4 US tertiary referral centers for evaluation of mesh-related complications after surgery for SUI and/or POP from January 2006 to December 2010. Demographic, clinical, and surgical data were abstracted from the medical record, and complications were classified according to the Expanded Accordion Severity Classification. RESULTS:Three hundred forty-seven patients sought management of synthetic mesh-related complications over the study period. Index surgeries were performed for the following indications: SUI (sling only), 49.9%; POP (transvaginal mesh [TVM] or sacrocolpopexy only), 25.6%; and SUI + POP (sling + TVM or sacrocolpopexy), 24.2%. Median time to evaluation was 5.8 months (range, 0-65.2). Thirty percent of the patients had dyspareunia; 42.7% of the patients had mesh erosion; and 34.6% of the patients had pelvic pain. Seventy-seven percent of the patients had a grade 3 or 4 (severe) complication. Patients with TVM or sacrocolpopexy were more likely to have mesh erosion and vaginal symptoms compared with sling only. The median number of treatments for mesh complications was 2 (range, 1-9); 60% of the women required ≥2 interventions. Initial treatment intervention was surgical for 49% of subjects. Of those treatments that initially were managed nonsurgically, 59.3% went on to surgical intervention. CONCLUSION:Most of the women who seek management of synthetic mesh complication after POP or SUI surgery have severe complications that require surgical intervention; a significant proportion require >1 surgical procedure. The pattern of complaints differs by index procedure.

journal_name

Am J Obstet Gynecol

journal_title

American journal of obstetrics and gynecology

authors

Abbott S,Unger CA,Evans JM,Jallad K,Mishra K,Karram MM,Iglesia CB,Rardin CR,Barber MD

doi

10.1016/j.ajog.2013.10.012

subject

Has Abstract

pub_date

2014-02-01 00:00:00

pages

163.e1-8

issue

eissn

0002-9378

issn

1097-6868

pii

S0002-9378(13)01065-X

journal_volume

210

pub_type

杂志文章,多中心研究

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Evaluation and management of complications from synthetic mesh after pelvic reconstructive surgery: a multicenter study.