Risk factors for mesh erosion after female pelvic floor reconstructive surgery: a systematic review and meta‐analysis

Abstract

ObjectivesTo explore the risk factors for mesh erosion after female pelvic floor reconstructive surgery based on published literature. Materials and MethodsA systematic literature search of the PubMed, Embase, Cochrane Library, Chinese Biomedical Literature (CBM), China National Knowledge Infrastructure (CNKI) and Chinese Science and Technology Periodical (VIP) databases was performed to identify studies related to the risk factors for mesh erosion after female pelvic floor reconstruction published before December 2014. Summary unadjusted odds ratios (ORs) with 95% confidence intervals (CIs) were calculated to assess the strength of associations between the factors and mesh erosion. ResultsIn all, 25 studies containing 7 084 patients were included in our systematic review and meta-analysis. Statistically significant differences in mesh erosion after female pelvic floor reconstruction were found in older vs younger patients (OR 0.96, 95% CI 0.94-0.98), more parities vs less parities (OR 1.27, 95% CI 1.07-1.51), the presence of premenopausal/ oestrogen replacement therapy (ERT) (OR 1.36, 95% CI 1.03-1.79), diabetes mellitus (OR 1.87, 95% CI 1.35-2.57), smoking (OR 2.35, 95% CI 1.80-3.08), concomitant pelvic organ prolapse (POP) surgery (OR 0.37, 95% CI 0.16-0.84), concomitant hysterectomy (OR 1.46, 95% CI 1.03-2.07), preservation of the uterus at surgery (OR 0.22, 95% CI 0.08-0.63), and surgery performed by senior vs junior surgeons (OR 0.42,). ConclusionOur study indicates that younger age, more parities, premenopausal/ERT, diabetes mellitus, smoking, concomitant hysterectomy, and surgery performed by a junior surgeon were significant risk factors for mesh erosion after female pelvic floor reconstructive surgery. Moreover, concomitant POP surgery and preservation of the uterus may be the potential protective factors for mesh erosion.

Risk factors for vaginal mesh erosion after sacrocolpopexy in Korean women

“…First, this is the first study to investigate the risk factors for vaginal mesh erosion after SCP in an Asian population. Although our findings may not be Risk factors for vaginal mesh erosion after sacrocolpopexy in Korean women applicable to women of other ethnic backgrounds, a recent systematic review that included various races also demonstrated that premenopause or ERT is a significant risk factor for mesh erosion after female pelvic floor reconstructive surgery [29]. Second, all surgeries were performed with type 1 polypropylene mesh by a single expert surgeon, which minimizes the possible confounding effects of different surgical techniques or skill levels and mesh type on the outcome.…”

Factors that affect outcomes of prolapse repair using single‐incision vaginal mesh procedures

“…4 Associated risk factors may include patient comorbidities, concomitant hysterectomy, and a junior surgeon, etc. 22 Recent studies of Elevate reported consistently low (0-6.3%) rates of vaginal mesh exposure but the influencing factors have not been explored yet. 7,[10][11][12][13] In this study, patient comorbidities, concomitant hysterectomies (more cases in the Elevate group) did not seem to affect the low exposure rate in the Elevate group, and that could be the result of using the new lightweight meshes and also a better surgeons' experience when performing Elevate at a later period.…”

Combined reconstructive surgery involving uterosacral colpopexy and anterior vaginal mesh implantation for pelvic organ prolapse

“…Dissection of the paravesical cavity around the tendinous arch was easily achieved through the vaginal stump. Concomitant hysterectomy has been reported to increase the risk of mesh erosion, although contrary findings have also been reported …”

“…Concomitant hysterectomy has been reported to increase the risk of mesh erosion, although contrary findings have also been reported. 30,31 We removed the uterus vaginally in all cases. New vaginal mesh operations, such as those involving the Elevate or Uphold systems, are suitable for cases in which the patient wishes to preserve their uterus.…”