Joint position statement on the management of mesh-related complications for the FPMRS specialist

Abstract

The scientific approach to categorizing mesh complications and optimal methods to address them have been complicated by the rapid proliferation and evolution of materials and techniques that have been used over the past 20 years in surgical treatment of pelvic floor disorders. In addition, terminology used to diagnose and categorize mesh complications and the descriptions of surgical procedures to manage them have been adopted inconsistently, further hampering the development of a collective experience with a standardized lexicon. Finally, much of the high-quality data on management of mesh complications is based on materials that are rarely used or not commercially available today.Women experiencing mesh complications need to be heard and should have access to resources and providers who are most able to help. Many women require multiple procedures to address their mesh complications, and for some of these patients, relief is incomplete. We should strive to optimize the treatment at the initial diagnosis of a mesh-related complication.This Position Statement has 4 goals: 1. Using the best and most relevant evidence available, provide guidance for the FPMRS subspecialist caring for patients who may be experiencing mesh complications 2: Provide an algorithm outlining treatment choices for patients with mesh-related complications that can be used as a platform for shared decision making in the treatment of these complications 3: Identify and prioritize gaps in evidence concerning specific mesh complications and their treatments 4: Identify provider and health facility characteristics that may optimize the outcomes of treatments for these complications Keywords pelvic floor disorder . mesh complications Providers caring for women with pelvic floor disorders are aware that surgery has attendant risks that counterbalance the benefits. Decisions concerning the balance of risks and benefits should be made in collaboration with each patient. In recent decades, frustration with surgical failures has prompted development of materials and techniques using synthetic mesh. In some circumstances, these techniques seem to confer durability, but the implants themselves introduce unique risks. The 2011 Update to the Food and Drug Administration's Public Health Notification regarding use of transvaginal mesh (TVM) stated that these complications are not rare and can be difficult to treat. The scientific approach to categorizing mesh complications and optimal methods to address them have been complicated by the rapid proliferation and evolution of materials and techniques that have been used over the past 20 years in surgical treatment of The AAGL endorses this document. The Society of Gynecologic Surgeons supports this document. Individual contributors are noted in the Acknowledgments section. This report is being published concurrently in Female Pelvic Medicine and Reconstructive Surgery and in International Urogynecology Journal. The report is identical except for minor stylistic and spelling differences in keeping with each jou...

From Open to Minimally Invasive: The Sacrocolpopexy

“…Surgery can occur via transvaginal excision, endoscopic assisted transvaginal excision, open laparotomy, or by minimally invasive intraperitoneal laparoscopic or robotic surgery. A literature review on the topic reveals no standard protocol for osteomyelitis related to POP-mesh [52,[56][57][58]. In February 2020, American Society of Obstetrics and Gynecology (ACOG) and International Urogynecological Association (IUGA) published a Joint Position to guide the management of mesh complications [57,58].…”

“…A literature review on the topic reveals no standard protocol for osteomyelitis related to POP-mesh [52,[56][57][58]. In February 2020, American Society of Obstetrics and Gynecology (ACOG) and International Urogynecological Association (IUGA) published a Joint Position to guide the management of mesh complications [57,58]. Asymptomatic mesh exposure after SCP can be observed (Grade C recommendation) while understanding that three of four exposures will not resolve and may require surgery [57], which heals 93% of patients [59].…”

Marjolin’s Ulcer: Mesh-Related Vaginal Cutaneous Fistula With Superimposed Osteomyelitis and Neoplastic Transformation

“…Treatment optimization should include the following goals: use of relevant evidence to help guide the FPMRS subspecialist caring for patients with mesh complications, a treatment algorithm that can be used for shared decision making, identify and prioritize gaps in evidence related to specific mesh complications and treatment options, and identify provider and health facility characteristics that may optimize treatment outcomes specific to mesh complications [20].…”

Current situation of complications related to reconstructive surgery for pelvic organ prolapse: a multicenter study

“…In this study, we analyzed data collected between November 2017 and October 2019. We used the terminology laid out by the International Urogynecological Association (IUGA), International Continence Society (ICS), and American Urogynecological Society (AUGS) [10,11].…”

“…These patients might suffer from mesh-related complications in the future. However, no standard management of mesh complications is available now [10]. It is important to prospectively follow-up and register the patients who received synthetic mesh surgeries, which would help to establish standard managements for mesh complications, and explore the potential patients who would benefit from synthetic mesh surgery to repair POP.…”