Mp33-20 Synthetic Mid-urethral Sling Complications: Evolution of Presenting Symptoms Over Time
Year: 2018
Type: article
Study design: Observational Study
Abstract: METHODS: This was an IRB-approved, retrospective review of our patients who underwent POP mesh removal from 2009-2016.Factors of interest included mesh type (transvaginal (TV) or sacrocolpopexy (SCC)), complete vs. partial removal, and presenting symptoms.Complete removal was defined as complete excision of all possible mesh from the anterior and posterior paravaginal space including mesh arms.Partial removal included anything less than complete removal.Postoperative pain improvement was categorized as resolved (symptoms resolved and require no further therapy), improved (symptoms less bothersome, may require further therapy), or unresolved (no/minimal improvement and require further management).Recurrent prolapse was also determined.RESULTS: 76 mesh removal patients (63 TV, 8 SCC, 5 unknown) were identified with a mean age of 60 and mean follow-up of 20 months.Overall, symptoms prompting mesh removal resolved or improved in 84%, with 54% classified as resolved, 30% improved, 11% unresolved, and 5% lost to follow-up.In the 37 complete removal patients, 54.1% were resolved, 35.1% improved, and 10.8% unresolved compared to 60% resolved, 28.6% improved, and 11.4% unresolved in the 35 partial removal patients (?2¼0.36, p¼0.84).32.4% of complete mesh removal patients developed recurrent prolapse, compared to 20.0% after partial mesh removal (p¼0.2).Pain/dyspareunia was the indication for removal in 79% (60/76) of patients, and in this subset 53% were resolved, 37% improved, and 10% were unresolved.In the pain subset, there was no significant difference in pain resolution between complete (34 patients) vs partial (26 patients) removal (53% vs. 58% resolved, respectively, ?2¼0.4,p¼0.82).In the pain subset, 35.3% (12/ 34) of patients developed recurrent prolapse after complete removal, compared to 15.4%(4/26) after partial removal (?2¼2.0, p¼0.15).Overall, 21 (27%) patients in the entire cohort required repeat reconstructive procedures after mesh removal.CONCLUSIONS: Following removal of vaginal mesh, most patients experienced resolution or improvement in presenting symptoms, including pain.Complete mesh removal was not significantly associated with symptom improvement or recurrent prolapse.Less than one-third of patients undergoing mesh removal required repeat vaginal prolapse surgery.
Source: The Journal of Urology
Authors: Connie Wang, Alana Christie, Philippe Zimmern
Language: English
Subfield: Rheumatology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2796079520