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

Abstract

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.

Clinical outcomes after total excision of transobturator tape inserted for treatment of stress urinary incontinence

“…It is therefore possible that the true incidence of SUI after TETOT has not been accurately reported. High rates of loss to follow‐up (60%−70%) have been common in studies reporting outcomes after mesh excision 8,12 . A review of the literature revealed commonality between other studies—frequently, studies reporting outcomes of stress incontinence after mesh excision typically carry heterogenous groups of MUT routes, report outcomes over a short period of time, and are limited to vaginal excisions 8,9,20–23 .…”

“…8,12 A review of the literature revealed commonality between other studies-frequently, studies reporting outcomes of stress incontinence after mesh excision typically carry heterogenous groups of MUT routes, report outcomes over a short period of time, and are limited to vaginal excisions. 8,9,[20][21][22][23] These rates cannot be generalized to those undergoing TETOT, in the longterm. Rates of worsening and new stress incontinence provide clinicians with essential information to counsel women.…”

“…High rates of loss to follow-up (60% −70%) have been common in studies reporting outcomes after mesh excision. 8,12 A review of the literature revealed commonality between other studies-frequently, studies reporting outcomes of stress incontinence after mesh excision typically carry heterogenous groups of MUT routes, report outcomes over a short period of time, and are limited to vaginal excisions. 8,9,[20][21][22][23] These rates cannot be generalized to those undergoing TETOT, in the longterm.…”

“…7 To date, the reported case series of mesh excision have been too heterogenous to provide individual women information about the outcome of mesh excision as a treatment for pain. [8][9][10][11][12] National Institute for Health and Care Excellence (NICE) found that there is insufficient evidence to guide the management of pain secondary to mesh. 13 Pain associated with a MUT may be managed in a number of ways.…”

Roadmap on biomaterials for women’s health

“…Once integrated into pelvic tissues, mesh cannot be easily removed (if at all) and in some instances the reoperation results in significant removal of portions of the vagina. Despite mesh removal, often complications (especially pain) fail to resolve [82]. This is particularly concerning given that approximately 12.6% of women will undergo surgery to repair POP by age 80 and this percentage is expected to rise (∼50%) by 2050 [79,83].…”