Management of Erosion of Graft Materials in Pelvic Floor Reconstruction

Abstract

We present an overview of the current literature and management techniques for vaginal extrusion or urinary tract erosion of graft materials used in pelvic floor reconstruction. A MEDLINE search was performed to identify literature pertaining to the incidence and management of vaginal or urinary tract exposure of graft materials commonly used in anti-incontinence and pelvic floor reconstructive procedures. Dependent on the type of mesh material used, a vaginal extrusion rate of up to 77% has been reported. The currently accepted, loosely woven, monofilament type I polypropylene meshes appear to have acceptable lower exposure rates in the range of 1–3% for slings, but with the larger area of mesh used in prolapse repairs, the rate increases to up to 10%. With the current widespread use of graft materials to reinforce pelvic floor reconstructive techniques, it is imperative for surgeons to be familiar with potential complications related to the materials and proper management of these complications. Although it is beginning to appear that the benefit of using some synthetic materials may outweigh the risks, proper management and understanding of the risks is important in order to counsel our patients appropriately and responsibly prior to their surgeries.

Risk factors for mesh complications after trocar guided transvaginal mesh kit repair of anterior vaginal wall prolapse

“…However, studies also show that use of mesh kits results in higher rates of postoperative adverse events, of which mesh related complications are a significant cause of morbidity 2. The clinical manifestations of a host‐versus‐implant reaction range from mild inflammatory reactions that can be handled conservatively, to severe exposures and graft extrusion requiring secondary surgery 3. Adverse mesh reactions are therefore of major concern in relation to the use of foreign body materials for pelvic reconstructive surgery 4…”

“…2 The clinical manifestations of a hostversus-implant reaction range from mild inflammatory reactions that can be handled conservatively, to severe exposures and graft extrusion requiring secondary surgery. 3 Adverse mesh reactions are therefore of major concern in relation to the use of foreign body materials for pelvic reconstructive surgery. 4 The risk of an adverse immunological response is, among other factors influenced by biomechanical properties of the foreign material, as well as, the host immune system.…”

Protective Biofilms in Obstetrics and Gynecology May Be Therapeutic Targets to Reduce Surgical and Delivery Complications

“…49 Further, surgical mesh used for surgical management of stress incontinence and prolapse repair has an exposure complication rate of up to 10-26%. 50,51 Klutke et al presented a case of a 47-year-old woman treated for stress urinary incontinence with transobturator tape placement, complicated by mesh exposure 2 months postoperatively. Although routine cultures obtained from removed mesh were negative, molecular techniques using fluorescent in situ hybridization and confocal laser-scanning microscopy revealed dense biofilm of non-Lactobacillus cocci.…”

Update on Lower Urinary Tract Symptoms

“…The material, technique (surgeon), and host (patient) form a three-legged stool on which rests the outcome. So when complications of the procedure occur, is it the product, the technique, or the host environment that cause the question detailed by Dr. Kobashi [8]. She has had the clinical experience with a variety of materials as well as the database to track the long-term outcomes.…”