A Retrospective Analysis of Surgical Outcomes and Risk Factors for Persistent Postoperative Symptoms Following Synthetic Mid Urethral Sling Revision

Dray, Elizabeth; Crosby, Elizabeth C.; Grable, Ashley; Crescenze, Irene; Stoffel, John T.; Clemens, J. Quentin; Cameron, Anne P.

doi:10.1097/ju.0000000000000246

Cited by 15 publications

(13 citation statements)

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“…Preoperative narcotic use is a known risk factor for ongoing postoperative pain in patients undergoing synthetic mid-urethral sling revision or removal (odds ratio 6.9). 22 The association between preoperative narcotics and poor postoperative outcomes has also been reported in other surgical subspecialties. [28][29][30] We identified higher rates of past or current smoking among patients undergoing sling removal, however, there were no differences when patients were stratified by complication type.…”

Section: Discussionmentioning

confidence: 82%

Symptomatic improvement after mesh removal: a prospective longitudinal study of women with urogynaecological mesh complications

Pace

Baranski

Palcsey

et al. 2021

BJOG

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Objective To compare clinical characteristics and outcomes in patients undergoing excision of polypropylene urogynaecological mesh for pain, mesh exposure or both.Design Prospective, longitudinal cohort.Setting Academic tertiary referral centre.Population Women undergoing complete vaginal mesh excision for mesh exposure and/or pain.Methods Clinical and patient-reported outcomes assessing pain (visual analog scale, VAS), bother (Pelvic Floor Distress Inventory, PFDI) and functional impact (Pelvic Functional Impact Questionnaire, PFIQ) were collected at baseline, 6, 12 and 24 months after complete mesh excision. Outcomes were compared by mesh type (sling, prolapse [transvaginal or sacrocolpopexy mesh], both) and complication (pain, exposure, both).Main outcome measures 'Much better' or 'Very much better' on Patient Global Impression of Improvement (PGI-I) up to 2 years after removal.Results Of 173 women, 48 underwent removal for pain, 27 for exposure and 98 for exposure plus pain. 'Moderate to severe' baseline symptoms were reported by 75%; the most prevalent and severe symptom was dyspareunia. Patients with pain alone were most bothered (PFDI median 234.2, interquartile range 83, P = 0.02) and had the highest functional impact (PFIQ median 181, interquartile range 138, P < 0.001). After excision, only 33.3% of women with pain alone reported 'improved' symptoms (PGI-I), versus 73.9% with exposure, 58.3% with exposure plus pain (P = 0.03) with no differences in PGI-I by mesh type. VAS scores decreased in all groups, but PFDI and PFIQ did not improve in pain patients.Conclusions In women experiencing a pain complication after urogynaecological mesh insertion, mesh removal often does not improve symptoms.

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Section: Discussionmentioning

confidence: 82%

Symptomatic improvement after mesh removal: a prospective longitudinal study of women with urogynaecological mesh complications

Pace

Baranski

Palcsey

et al. 2021

BJOG

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“…Recently, Dray et al published persistence of pain in 42.3% of patients undergoing revision surgery for pain related to mesh, and de novo pain in 6.3% in a tertiary care hospital for sling revision. 39 Voiding dysfunction If bladder outlet obstruction or voiding dysfunction from a tight sling is diagnosed early (up to 2-3 weeks) after surgery, tape loosening is appropriate. After 2-3 weeks, 40,41 because of fibrosis and scarring, lysis/division is the preferred procedure, with risk of recurrence of SUI in up to 63% of patients.…”

Section: Painmentioning

confidence: 99%

Section: Management Of Mesh-related Complicationsmentioning

confidence: 99%

Mesh complications: best practice in diagnosis and treatment

Reyes

Hashim

2020

Therapeutic Advances in Urology

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Mesh was a promising, minimally invasive, and ‘gold standard’ treatment for urinary stress incontinence. Time has shown that complications from these devices can happen early, or even several years, after mesh placement and can be catastrophic. Pain, erosion, voiding dysfunction, infection, recurrent UTIs [urinary tract infections (UTIs)], fistulae, organ perforation, bleeding, vaginal scarring, neuromuscular alterations, LUTS (lower urinary tract symptoms), bowel complications and even immune disorders have been linked to mesh. Various tools, such as imaging, endoscopic and functional studies, are available for diagnosis of mesh complications. Since the spectrum of complications is wide, involvement of other specialties is usually beneficial in the diagnosis and management of these complications. There is still much to learn on the accuracy and utility of diagnostic studies in each type of complication. Evidence on the best diagnostic and treatment pathways for these complications is scarce but continuously growing as information is being reported, and we continue to gain expertise in dealing with patients affected by mesh. Treatment options include conservative and medical management initially and then open or minimally invasive surgical procedure approaches. This article will describe diagnostic and treatment pathways for mesh complications.

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“…As referred to in the study, preoperative narcotic use is a known risk factor for ongoing postoperative pain in patients undergoing synthetic mid-urethral sling revision or removal (odds ratio 6.9). 3 Although preoperative pain is a risk factor for its postoperative presence, genuine de novo pain can occur after pelvic reconstructive surgery for stress urinary incontinence or pelvic organ prolapse with and without mesh. Depending on the definition used, reported mesh-related pain rates range between 4 and 11%.…”

mentioning

confidence: 99%

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

Gracia

Tayrac

2021

BJOG

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A Retrospective Analysis of Surgical Outcomes and Risk Factors for Persistent Postoperative Symptoms Following Synthetic Mid Urethral Sling Revision

Cited by 15 publications

References 0 publications

Symptomatic improvement after mesh removal: a prospective longitudinal study of women with urogynaecological mesh complications

Symptomatic improvement after mesh removal: a prospective longitudinal study of women with urogynaecological mesh complications

Mesh complications: best practice in diagnosis and treatment

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

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