Beyond the complications: medium-term anatomical, sexual and functional outcomes following removal of trocar-guided transvaginal mesh. A retrospective cohort study
Introduction and hypothesis
The aims of this study were to assess the anatomical, sexual and functional outcomes of women undergoing surgical intervention for complications of the trocar-guided transvaginal mesh (TVM) procedure.
This was a retrospective analysis of a clinical database of women who had developed a complication following a TVM procedure. This included dyspareunia, mesh erosion, urinary symptoms, mesh contraction and prolapse recurrence. Pre- and post-operatively, we assessed the women for prolapse, stress incontinence, urgency, defecatory difficulty, digitation, pain, dyspareunia and apareunia. We also recorded the Pelvic Organ Prolapse Quantification (POP-Q) score. The TVM was removed and a Biodesign graft was used in the majority of cases to prevent further prolapse. Follow-up was at 6 weeks, 6 months, 1 and 2 years.
In our cohort of 21 women, 18 required surgery for pain and/or dyspareunia; 20 women had reached the 6-week follow-up at the time of analysis. At 6 weeks, two women still had pain and required a second intervention. Fifteen women had reached a 6-month follow-up and only one woman had persistent pain requiring repeat surgery. Of the 15 women, 7 were sexually active and in 6 cases the dyspareunia had resolved completely with 1 woman retaining an element of pain at intercourse. Six women had been seen at 12 months and all four of the sexually active women had no dyspareunia. There were no symptoms relating to prolapse in any of the women at 6 weeks, 6, 12 or 24 months.
We report satisfactory outcomes following removal of a complicated TVM kit.
KeywordsTVM Mesh kit complication Prolapse Vaginal pain Dyspareunia Prolift
Danette Nieuwoudt helped with data collection.
Conflicts of interest
No funding was provided for this paper. Dr. Jeffery has received travel sponsorship from Johnson and Johnson, Boston Scientific, American Medical Systems, Cook and Bard. He has also received speakers fees and honoraria from Johnson and Johnson, Boston Scientific, American Medical Systems and Bard. He is a trainer for Johnson and Johnson, Boston Scientific and American Medical Systems. Dr. Nieuwoudt has received speakers fees and honoraria from Cook Medical and Gynecare (Johnson and Johnson)—all funds were paid into the account of his employer, Stichting Zorgsaam.
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