International Urogynecology Journal

, Volume 20, Issue 5, pp 523–531 | Cite as

Complications from vaginally placed mesh in pelvic reconstructive surgery

  • Roberta E. Blandon
  • John B. Gebhart
  • Emanuel C. Trabuco
  • Christopher J. Klingele
Original Article

Abstract

Introduction and hypothesis

We describe complications associated with the use of transvaginal mesh for treatment of pelvic organ prolapse.

Methods

We retrospectively identified patients referred to our institution from January 2003 through September 2007 who had complications after vaginal placement of mesh.

Results

We identified 21 patients with a mean (SD) age of 61 (11) years. Types of mesh used included mesh kits (n = 9, 43%), nontrocar mesh augmentation (n = 5, 24%), IVS Tunneller (n = 4, 19%), and unspecified (n = 3, 14%). Eleven patients (52%) underwent more than one procedure before referral. Only three patients were referred by the original treating surgeon. Complications included mesh erosions in 12 women, dyspareunia in ten, and recurrent prolapse in nine. Sixteen patients (76%) were managed surgically. Follow-up survey among sexually active patients showed 50% with persistent dyspareunia.

Conclusions

Use of vaginal mesh for pelvic reconstruction can produce complications. Multiple interventions may be necessary, and bothersome symptoms may persist.

Keywords

Dyspareunia Mesh erosion Mesh kits Minimally invasive Recurrent prolapse 

Notes

Conflict of interest

John B. Gebhart, MD, has grant/research support from CR Bard, Inc.

References

  1. 1.
    Shull BL, Capen CV, Riggs MW, Kuehl TJ (1992) Preoperative and postoperative analysis of site-specific pelvic support defects in 81 women treated with sacrospinous ligament suspension and pelvic reconstruction. Am J Obstet Gynecol 166:1764–1768PubMedGoogle Scholar
  2. 2.
    Weber AM, Walters MD, Piedmonte MR, Ballard LA (2001) Anterior colporrhaphy: a randomized trial of three surgical techniques. Am J Obstet Gynecol 185:1299–1304PubMedCrossRefGoogle Scholar
  3. 3.
    Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL (1997) Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol 89:501–506PubMedCrossRefGoogle Scholar
  4. 4.
    Luijendijk RW, Hop WC, van den Tol MP, de Lange DC, Braaksma MM, IJzermans JNM (2000) A comparison of suture repair with mesh repair for incisional hernia. N Engl J Med 343:392–398PubMedCrossRefGoogle Scholar
  5. 5.
    Baessler K, Maher CF (2006) Mesh augmentation during pelvic-floor reconstructive surgery: risks and benefits. Curr Opin Obstet Gynecol 18:560–566PubMedCrossRefGoogle Scholar
  6. 6.
    Julian TM (1996) The efficacy of Marlex mesh in the repair of severe, recurrent vaginal prolapse of the anterior midvaginal wall. Am J Obstet Gynecol 175:1472–1475PubMedCrossRefGoogle Scholar
  7. 7.
    Dwyer PL, O’Reilly BA (2004) Transvaginal repair of anterior and posterior compartment prolapse with Atrium polypropylene mesh. BJOG 111:831–836PubMedCrossRefGoogle Scholar
  8. 8.
    Achtari C, Hiscock R, O’Reilly BA, Schierlitz L, Dwyer PL (2005) Risk factors for mesh erosion after transvaginal surgery using polypropylene (Atrium) or composite polypropylene/polyglactin 910 (Vypro II) mesh. Int Urogynecol J Pelvic Floor Dysfunct 16:389–394PubMedCrossRefGoogle Scholar
  9. 9.
    Debodinance P, Cosson M, Collinet P, Boukerrou M, Lucot JP, Madi N (2006) Synthetic meshes for transvaginal surgical cure of genital prolapse: evaluation in 2005. J Gynecol Obstet Biol Reprod (Paris) 35:429–454Google Scholar
  10. 10.
    Altman D, Falconer C (2007) Perioperative morbidity using transvaginal mesh in pelvic organ prolapse repair. Obstet Gynecol 109:303–308PubMedGoogle Scholar
  11. 11.
    de Tayrac R, Devoldere G, Renaudie J, Villard P, Guilbaud O, Eglin G (2007) Prolapse repair by vaginal route using a new protected low-weight polypropylene mesh: 1-year functional and anatomical outcome in a prospective multicentre study. Int Urogynecol J Pelvic Floor Dysfunct 18:251–256PubMedCrossRefGoogle Scholar
  12. 12.
    Fatton B, Amblard J, Debodinance P, Cosson M, Jacquetin B (2007) Transvaginal repair of genital prolapse: preliminary results of a new tension-free vaginal mesh (Prolift technique): a case series multicentric study. Int Urogynecol J Pelvic Floor Dysfunct 18:743–752PubMedCrossRefGoogle Scholar
  13. 13.
    Baessler K, Hewson AD, Tunn R, Schuessler B, Maher CF (2005) Severe mesh complications following intravaginal slingplasty. Obstet Gynecol 106:713–716PubMedGoogle Scholar
  14. 14.
    Baden WF, Walker TA (1972) Genesis of the vaginal profile: a correlated classification of vaginal relaxation. Clin Obstet Gynecol 15:1048–1054PubMedCrossRefGoogle Scholar
  15. 15.
    Barber MD, Walters MD, Bump RC (2005) Short forms of two condition-specific quality-of-life questionnaires for women with pelvic floor disorders (PFDI-20 and PFIQ-7). Am J Obstet Gynecol 193:103–113PubMedCrossRefGoogle Scholar
  16. 16.
    Yalcin I, Bump RC (2003) Validation of two global impression questionnaires for incontinence. Am J Obstet Gynecol 189:98–101PubMedCrossRefGoogle Scholar
  17. 17.
    Rogers RG, Coates KW, Kammerer-Doak D, Khalsa S, Qualls C (2003) A short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). Int Urogynecol J Pelvic Floor Dysfunct 14:164–168PubMedCrossRefGoogle Scholar
  18. 18.
    Paraiso MF, Barber MD, Muir TW, Walters MD (2006) Rectocele repair: a randomized trial of three surgical techniques including graft augmentation. Am J Obstet Gynecol 195:1762–1771PubMedCrossRefGoogle Scholar
  19. 19.
    Weber AM, Walters MD, Piedmonte MR (2000) Sexual function and vaginal anatomy in women before and after surgery for pelvic organ prolapse and urinary incontinence. Am J Obstet Gynecol 182:1610–1615PubMedCrossRefGoogle Scholar
  20. 20.
    Hiltunen R, Nieminen K, Takala T, Heiskanen E, Merikari M, Niemi K (2007) Low-weight polypropylene mesh for anterior vaginal wall prolapse: a randomized controlled trial. Obstet Gynecol 110:455–462PubMedGoogle Scholar
  21. 21.
    Bump RC, Mattiasson A, Bo K, Brubaker LP, DeLancey JO, Klarskov P (1996) The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol 175(1):10–17PubMedCrossRefGoogle Scholar
  22. 22.
    Deffieux X, de Tayrac R, Huel C, Bottero J, Gervaise A, Bonnet K (2007) Vaginal mesh erosion after transvaginal repair of cystocele using Gynemesh or Gynemesh-Soft in 138 women: a comparative study. Int Urogynecol J Pelvic Floor Dysfunct 18:73–79PubMedCrossRefGoogle Scholar
  23. 23.
    Migliari R, De Angelis M, Madeddu G, Verdacchi T (2000) Tension-free vaginal mesh repair for anterior vaginal wall prolapse. Eur Urol 38:151–155PubMedCrossRefGoogle Scholar
  24. 24.
    Choe JM, Ogan K, Bennett S (2000) Antibacterial mesh sling: a prospective outcome analysis. Urology 55:515–520PubMedCrossRefGoogle Scholar
  25. 25.
    Collinet P, Belot F, Debodinance P, Ha Duc E, Lucot JP, Cosson M (2006) Transvaginal mesh technique for pelvic organ prolapse repair: mesh exposure management and risk factors. Int Urogynecol J Pelvic Floor Dysfunct 17:315–20PubMedCrossRefGoogle Scholar
  26. 26.
    Nygaard IE, McCreery R, Brubaker L, Connolly A, Cundiff G, Weber AM (2004) Abdominal sacrocolpopexy: a comprehensive review. Obstet Gynecol 104:805–823PubMedGoogle Scholar
  27. 27.
    Tunuguntla HS, Gousse AE (2006) Female sexual dysfunction following vaginal surgery: a review. J Urol 175:439–446PubMedCrossRefGoogle Scholar
  28. 28.
    Pauls RN, Silva WA, Rooney CM, Siddighi S, Kleeman SD, Dryfhout V (2007) Sexual function after vaginal surgery for pelvic organ prolapse and urinary incontinence. Am J Obstet Gynecol 197:622.e1–622.e7CrossRefGoogle Scholar
  29. 29.
    Milani R, Salvatore S, Soligo M, Pifarotti P, Meschia M, Cortese M (2005) Functional and anatomical outcome of anterior and posterior vaginal prolapse repair with Prolene mesh. BJOG 112:107–111PubMedCrossRefGoogle Scholar

Copyright information

© The International Urogynecological Association 2009

Authors and Affiliations

  • Roberta E. Blandon
    • 1
  • John B. Gebhart
    • 1
  • Emanuel C. Trabuco
    • 1
  • Christopher J. Klingele
    • 1
  1. 1.Department of Obstetrics and GynecologyMayo ClinicRochesterUSA

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