Risk factors for vaginal mesh erosion after sacrocolpopexy in Korean women

Abstract

ObjectiveAlthough sacrocolpopexy (SCP) can provide durable apical support, the use of mesh may give rise to various complications, including vaginal mesh erosion. The aim of this study was to identify the risk factors for vaginal mesh erosion after SCP in Korean women. MethodsThis retrospective cohort study included 363 women who underwent SCP with type 1 polypropylene mesh. They were evaluated at 1, 4, and 12 months after surgery and then annually thereafter with respect to anatomy and complications. Univariate and multivariate analyses using the Cox proportional hazard model were performed to identify the risk factors for mesh erosion. ResultsDuring the median 2-year follow-up period, vaginal mesh erosion was found in 29 women (8.0%). Among them, 19 (65.5%) required surgical correction. Estrogenic status was the only independent risk factor for mesh erosion. The risk for mesh erosion was 4.5 times higher in premenopausal women than in menopausal women not on estrogen replacement therapy (ERT) (95% confidence intervals [CI] 1.9-10.9, p<0.01). Menopausal women on ERT also had an increased risk, with a statistically marginal significance (hazard ratio 2.5, 95% CI 0.9-6.6; p = 0.07).

Advanced Cystocele is a Risk Factor for Surgical Failure after Robotic-assisted Laparoscopic Sacrocolpopexy

“…Goretex and silicone-coated mesh [28,29], premenopausal state or estrogen-replacement therapy [30] and Ethibond sutures [11,22]. Given this finding, we switched to use PDS sutures.…”

Genital Prolapse Surgery: What Options Do We Have in the Age of Mesh Issues?

“…This may indicate that apical fixation alone is not effective. Mesh exposure in LSC (1–5%) has been reported in many publications (1–5%) [ 5 , 24 ]. Computer-based models showed that straight fixation causes extensive shear forces on the pelvic fascia in LSC, and may be inferior to bilateral fixation.…”

“…In some countries, the use of meshes in sacropexy is viewed critically by government agencies. The technique is still recognized as the “gold standard” in prolapse surgery [ 2 , 3 , 4 ], but the extensive use of deep mesh placement is associated with greater mesh exposure and shrinkage [ 5 ]. Degradation of the material is followed by its spread within the body.…”

New “Wrinkle Method” for Intracorporeal Anterior Vaginal Wall Plication during Sacrocolpopexy

“…Risk factors associated with vaginal mesh erosion can be classified as mesh-related, patient-related, and surgery-related. Monofilament, macroporous, light-weighted, and soft mesh can decrease mesh erosion; however, smoking, the use of steroids, diabetes, premenopause, estrogen replacement therapy during postmenopause, and an advanced stage of POP can increase mesh erosion [ 15 , 16 , 17 , 18 , 19 , 20 , 21 ]. Concomitant hysterectomy, intra-abdominal adhesions, and postoperative pelvic hematoma, lack of surgical experience, and incorrect indication may increase the risk of vaginal mesh erosion after SC [ 22 , 23 , 24 , 25 , 26 , 27 ].…”