The IUGA/ICS classification of synthetic mesh complications in female pelvic floor reconstructive surgery: a multicenter study

Miklos, John R.; Chinthakanan, Orawee; Moore, Robert D.; Mitchell, G.K.; Favors, Sheena; Karp, Deborah R.; Northington, Gina M.; Nogueiras, G.M.; Davila, G. Willy

doi:10.1007/s00192-015-2913-4

Cited by 44 publications

(11 citation statements)

References 15 publications

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“…Transvaginal polypropylene mesh for pelvic organ prolapse (POP) and stress urinary incontinence has been the subject of much controversy with its use being suspended in some countries as the result of complications, 1 and several series including the management of such complications have been published. 2 , 3 …”

Section: Introductionmentioning

confidence: 99%

How common are complications following polypropylene mesh, biological xenograft and native tissue surgery for pelvic organ prolapse? A secondary analysis from the PROSPECT trial

Reid

Elders

Breeman

et al. 2021

BJOG

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Objective To report complication rates following prolapse surgery using polypropylene mesh inlay, polypropylene mesh kit, biological collagen xenografts and native tissue repairs.Design Secondary analysis of the PROSPECT randomised controlled trial and cohort study.Setting Thirty-five UK hospitals.Population A total of 2632 women undergoing anterior and/or posterior vaginal prolapse repair.Methods Event rates were calculated for all complications. Analysis was by treatment received.Main outcome measures IUGA/ICS classification of complications and validated patient reported outcome measures.Results At baseline, 8.4% of women had 'generic' pain/discomfort; at 2 years following surgery, there was an improvement in all four groups; however, 3.0% of women developed de novo extreme generic pain. At 24 months de novo vaginal tightness occurred in 1.6% of native tissue, 1.2% of biological xenograft, 0.3% of mesh inlay and 3.6% of mesh kit. Severe dyspareunia occurred in 4.8% of native tissue, 4.2% of biological xenograft, 3.4% of mesh inlay repairs and 13.0% of mesh kits. De novo severe dyspareunia occurred in 3.5% of native tissue, 3.5% of biological xenograft, 1.4% of mesh inlays and 4.8% of mesh kits. Complications requiring re-admission to hospital, unrelated to mesh, affected 1 in 24 women; the most common reasons for re-admission were vaginal adhesions, urinary retention, infection and constipation.Conclusions This is the first study to address the complications of vaginal mesh used for prolapse surgery alongside data from both native tissue and biological xenograft. It demonstrates the complexity of assessing pain and that all types of prolapse surgery have low surgical morbidity and a low rate of severe complications.

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Section: Introductionmentioning

confidence: 99%

How common are complications following polypropylene mesh, biological xenograft and native tissue surgery for pelvic organ prolapse? A secondary analysis from the PROSPECT trial

Reid

Elders

Breeman

et al. 2021

BJOG

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“…Although PPL completely degrades over many years, its' inertness is now questioned after repeated demonstrations of surface degradation on the PPL fibers [56,57]. The most common complication of surgical implantation of the mesh is spontaneous pain, occurring in 32.5% patients (pain during sexual intercourse 14.7%) [58]. The mechanisms leading to this pain are complex, probably involving infection, nerve and muscle injury and mesh contraction [59].…”

Section: Biological Requirements Of Pelvic Floormentioning

confidence: 99%

Synthetic Materials Used in the Surgical Treatment of Pelvic Organ Prolapse: Problems of Currently Used Material and Designing the Ideal Material

Mangır¹,

Chapple²,

MacNeil³

2018

Pelvic Floor Disorders

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Synthetic materials have long been used to provide structural support when surgically repairing pelvic organ prolapse (POP). The most widely used synthetic material is a mesh made of polypropylene (PPL). The use of mesh is intended to improve cure rates and prevent recurrences after POP surgery -however as more mesh materials have been implanted, it has become apparent that serious complications can occur in up to 30% of women, particularly when the mesh is implanted transvaginally. Over the years many different mesh kits have been marketed and used in the treatment of POP however polypropylene mesh was never designed or tested for use in pelvic floor. Instead it was approved for clinical use based on its biocompatibility and success in abdominal hernia repairs. It is now known that PPL meshes are neither compliant with the mechanical forces in the pelvic floor nor do they integrate well into paravaginal tissues. Better materials developed specifically for use in pelvic floor are urgently needed. The aim of this chapter is to define the requirements of an ideal mesh in terms of its material properties and to summarize the ongoing research on developing the next generation pelvic floor repair materials.

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“…6 If mesh erosion occurs into hollow viscera, fistula may be formed, for example, vesicovaginal fistula in cases of erosions in urinary bladder (Category 4, IUGA/ICS classification) and rectovaginal or sigmoido-vaginal fistula in cases of erosions in bowel (Category 5, IUGA/ICS classification). 7 In cases of mesh erosion with concomitant hysterectomy, the site is nearly always at the vaginal cuff. This may be due to increased vaginal bacterial contamination of the mesh from an opened vagina during hysterectomy, or poor healing at the new cuff because of the devascularizing effects of mesh vaginal attachment sutures.…”

Section: Commentsmentioning

confidence: 99%

Mesh Erosion and Sigmoido-vaginal Fistula

Bajracharya

Dangal

Karki

et al. 2018

Nepal j. obstet. gynaecol.

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Abdominal sacro-colpopexy (ASC) is a commonly performed procedure for the surgical treatment of pelvic organ prolapse (POP). Surgeons favor this technique because of its well-established success rates ranging from 78-100% and durability, which is attributed to reinforcement of native tissues with a graft. Despite recognition of the risk of erosion, synthetic grafts have been preferred over autologous grafts for abdominal sacro-colpopexy because they are durable, avoid the morbidity and operative time of harvesting fascia, are readily available and are relatively inexpensive. Ideally, these benefits should outweigh the possibility of erosion, which is a unique complication of using a graft.We present here a unique case of mesh erosion into bowel after sacro-colpopexy who presented with sigmoido-vaginal fistula.

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The IUGA/ICS classification of synthetic mesh complications in female pelvic floor reconstructive surgery: a multicenter study

Abstract: Surgeons should be aware that patients with vaginal mesh complications routinely exhibit complications more than 1 year after the implantation with pain as the most common presenting symptom.

Cited by 44 publications

References 15 publications

How common are complications following polypropylene mesh, biological xenograft and native tissue surgery for pelvic organ prolapse? A secondary analysis from the PROSPECT trial

How common are complications following polypropylene mesh, biological xenograft and native tissue surgery for pelvic organ prolapse? A secondary analysis from the PROSPECT trial

Synthetic Materials Used in the Surgical Treatment of Pelvic Organ Prolapse: Problems of Currently Used Material and Designing the Ideal Material

Mesh Erosion and Sigmoido-vaginal Fistula

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