Pain Complications of Mesh Surgery

  • Lisa Rogo-Gupta
  • Shlomo RazEmail author
Part of the Current Clinical Urology book series (CCU)


Pelvic reconstructive surgery offers many treatments for pelvic organ prolapse. Surgical solutions include vaginal, laparoscopic, and abdominal approaches with native vaginal tissue, fascia autografts and allografts, xenografts, and synthetic absorbable and nonabsorbable mesh. Augmentation of traditional vaginal prolapse techniques using nonabsorbable synthetic mesh demonstrated low morbidity and high anatomic success when initially described. This seemingly reassuring data resulted in the rapid and widespread adoption of such techniques by Gynecologists and Urologists worldwide. Innumerable manufactured products (“kits”) for single or multiple compartment prolapse repair are available to pelvic surgeons. Mesh kits have many commonly known advantages such as tension-free placement design, simple technique that is easily repeated with minimal training, and short operative time and disadvantages including price, retraction, adherence, and the potential long-term effect of vaginal atrophy on the health of the mesh implant.


Pelvic Organ Prolapse Pudendal Nerve Synthetic Mesh Prolapse Repair Mesh Placement 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Savary D, Fatton B, Velemir L, Amblard J, Jacquetin B. What about transvaginal mesh repair of pelvic organ prolapse? Review of the literature since the HAS (French Health Authorities) report. J Gynecol Obstet Biol Reprod. 2009;38:11–41.CrossRefGoogle Scholar
  2. 2.
    Morrisroe S, Lee U, Raz S. The use of mesh in vaginal prolapse repair: do the benefits justify the risks? Curr Opin Urol. 2010;2:275–9.CrossRefGoogle Scholar
  3. 3.
    ACOG Practice. Bulletin Number 85, September 2007 (replaces practice bulletin number 79, February 2007). Clinical management guidelines for obstetrician-­gynecologists. Am J Obstet Gynecol. 2007;110:707–29.CrossRefGoogle Scholar
  4. 4.
    Murphy M. Society of Gynecologic Surgeons systematic review: clinical practice guidelines on vaginal graft use from the society of gynecologic surgeons. Obstet Gynecol. 2008;112:1123–30.PubMedCrossRefGoogle Scholar
  5. 5.
    Walter J. Transvaginal mesh procedures for pelvic organ prolapse: Society of Obstetricians and Gynaecologists of Canada technical update. J Obstet Gynaecol Can. 2011;33:168–74.PubMedGoogle Scholar
  6. 6.
    Maher C, Feiner B, Baessler K, Adams EJ, Hagen S, Glazener CM. Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev. 2007;3:CD004014.PubMedGoogle Scholar
  7. 7.
    United States Census Bureau, 2004. U.S. interim projections by age, sex, race, and hispanic origin. Accessed 1 Jan 2011.
  8. 8.
    Nieminen K, Hiltunen R, Heiskanen E, Takala T, Niemi K, Merikari M, et al. Symptom resolution and sexual function after anterior vaginal wall repair with and without polypropylene mesh. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19:1611–6.PubMedCrossRefGoogle Scholar
  9. 9.
    Kuhn A, Burkhard F, Eggemann C, Mueller MD. Sexual function after suburethral sling removal for dyspareunia. Surg Endosc. 2009;23:765–8.PubMedCrossRefGoogle Scholar
  10. 10.
    Beck RP, Grove D, Arnusch D, Harvey J. Recurrent urinary stress incontinence treated by fascia lata sling procedure. Am J Obstet Gynecol. 1974;120:613–21.PubMedGoogle Scholar
  11. 11.
    Beck RP, McCormick S, Nordstrom L. The fascia lata sling procedure for treating recurrent genuine stress incontinence. Obstet Gynecol. 1988;72:699–703.PubMedGoogle Scholar
  12. 12.
    Huguier J, Scali P. Posterior suspension of the genital axis on the lumbosacral disk in the treatment of uterine prolapsed. Presse Med. 1958;66:781–4.PubMedGoogle Scholar
  13. 13.
    Williams TJ, Te Linde RW. The sling operation for urinary incontinence using Mersilene ribbon. Obstet Gynecol. 1962;19:241–5.PubMedGoogle Scholar
  14. 14.
    Stanton SL, Brindley GS, Holmes DM. Silastic sling for urethral sphincter incompetence in women. Br J Obstet Gynaecol. 1985;92:747.PubMedCrossRefGoogle Scholar
  15. 15.
    Duckett JRA, Constantine F. Complications of silicone sling insertion for stress urinary incontinence. J Urol. 2000;163(6):1835–7.PubMedCrossRefGoogle Scholar
  16. 16.
    Rodriguez LV, Raz S. Prospective analysis of patients treated with distal urethral polypropylene slings for symptoms of stress urinary incontinence: 5-year outcomes. J Urol. 2003;170:849–51.CrossRefGoogle Scholar
  17. 17.
    Ostergard DR. Polypropylene vaginal mesh grafts in gynecology. Obstet Gynecol. 2010;116:962–6.PubMedCrossRefGoogle Scholar
  18. 18.
    Clavé A, Yahi H, Hammou JC, Montanari S, Gounon P, Clavé H. Polypropylene as a reinforcement in pelvic surgery is not inert: comparative analysis of 100 explants. Int Urogencol J Pelvic Floor Dysfunct. 2010;21:261–70.CrossRefGoogle Scholar
  19. 19.
    Garcia-Urena MA, Vega Ruiz V, Diaz Godoy A, Baez Perea JM, Marin Gomez LM, Carnero Hernandez FJ, et al. Differences in polypropylene shrinkage depending on mesh position in an experimental study. Am J Surg. 2007;193:538–42.PubMedCrossRefGoogle Scholar
  20. 20.
    Niro J, Phillipe AC, Jaffeux P, Ambiard J, Velemir L, Savary D, et al. Postoperative pain after transvaginal repair of pelvic organ prolapse with or without mesh. Gynecol Obstet Fertil. 2010;38:648–52.PubMedCrossRefGoogle Scholar
  21. 21.
    Moore RD, Davila GW. Vaginal mesh kits for prolapse 2010: update in technology and techniques to minimize complications. Female Patient. 2010;35:33–7.Google Scholar
  22. 22.
    The Manufacturer and User Facility Device Experience (MAUDE). Accessed 1 Jan 2011.
  23. 23.
    The United States Food and Drug Administration Medical Device Alerts and Notices on Surgical Mesh. Accessed 1 Jan 2011.
  24. 24.
    National Institute for Health and Clinical Excellence. Surgical repair of vaginal wall prolapse using mesh 2008. Accessed 1 Feb 2011.
  25. 25.
    Greenberg JA, Clark RM. Advances in suture material for obstetric and gynecologic surgery. Rev Obstet Gynecol. 2009;2:146–58.PubMedGoogle Scholar
  26. 26.
    Culligan P, Heit M, Blackwell L, Murphy M, Graham CA, Snyder J. Bacterial colony counts during vaginal surgery. Infect Dis Obstet Gynecol. 2003;11:161–5.PubMedCrossRefGoogle Scholar
  27. 27.
    Darouiche RO, Wall Jr MJ, Itani KM, Otterson MF, Webb AL, Carrick MM, et al. Chlorhexidine-alcohol versus povidone-iodine for surgical site antisepsis. N Engl J Med. 2010;362:18–26.PubMedCrossRefGoogle Scholar
  28. 28.
    Gristina AG. Biomaterial-centered infection: microbial adherence versus tissue integration. Science. 1987;237:1588–95.PubMedCrossRefGoogle Scholar
  29. 29.
    Junge K, Bunnebosel M, von Trotha K, Rosch R, Klinge U, Neuman UP, Jansen PL. Mesh biocompatibility effects of cellular inflammation and tissue remodeling. Langenbecks Arch Surg. 2012;397:255–70.PubMedCrossRefGoogle Scholar
  30. 30.
    Delavierre D, Rigaud J, Sibert L, Labat JJ. Definitions, classifications and terminology of chronic pelvic and perineal pain. Prog Urol. 2010;20:853–64.PubMedCrossRefGoogle Scholar
  31. 31.
    Lin LL, Haessler AL, Ho M, Betson LH, Alinsod RM, Bhatia NN. Dyspareunia and chronic pelvic pain after polypropylene mesh augmentation for transvaginal repair of anterior vaginal wall prolapse. Int Urogynecol J Pelvic Floor Dysfunct. 2007;18:675–8.PubMedCrossRefGoogle Scholar
  32. 32.
    Giri SK, Wallis F, Drumm J, Saunders JA, Flood HD. A magnetic resonance imaging-based study of retropubic haematoma after sling procedures: preliminary findings. BJU Int. 2005;96(7):1067–71.PubMedCrossRefGoogle Scholar
  33. 33.
    Fisher HW, Lotze PM. Nerve injury locations during retropubic sling procedures. Int Urogynecol J Pelvic Floor Dysfunct. 2011;22:439–41.CrossRefGoogle Scholar
  34. 34.
    Haylen BT, Freeman RM, Swift SE, Cosson M, Davila GW, Deprest J, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint terminology and classification of the complications related directly to the insertion of prosthesis (meshes, implants, tapes) & grafts in female pelvic floor surgery. Int Urogynecol J Pelvic Floor Dysfunct. 2011;22:3–15.CrossRefGoogle Scholar
  35. 35.
    Butrick CW, Sanford D, Hou Q, Mahnken JD. Chronic pelvic pain syndromes: clinical, urodynamic, and urothelial observations. Int Urogynecol J Pelvic Floor Dysfunct. 2009;20:1047–53.PubMedCrossRefGoogle Scholar
  36. 36.
    Feiner B, Maher C. Vaginal mesh contraction: definition, clinical presentation, and management. Obstet Gynecol. 2010;115:325–30.PubMedCrossRefGoogle Scholar
  37. 37.
    Marcus-Brown N, von Theobald P. Mesh removal following transvaginal mesh placement: a case series of 104 operations. Int Urogynecol J. 2010;21:423–30.CrossRefGoogle Scholar
  38. 38.
    Mucowski SJ, Jumalov C, Phelps JY. Use of vaginal mesh in the face of recent FDA warnings and litigation. Am J Obstet Gynecol. 2010;203:103.e1–4.Google Scholar
  39. 39.
    Barber MD, Brubaker L, Nygaard I, Wheeler II TL, Schaffer J, Chen Z, et al. Defining success after surgery for pelvic organ prolapse. Obstet Gynecol. 2009;114:600–9.PubMedCrossRefGoogle Scholar
  40. 40.
    Nieminen K, Hiltunen R, Takal T, Heiskanen E, Merikari M, Niemi K, et al. Outcomes after anterior vaginal wall repair with mesh: a randomized, controlled trial with a 3 year follow-up. Am J Obstet Gynecol. 2010;203:235.e1–8.Google Scholar
  41. 41.
    Withagen MI, Milani AL, den Boon J, Vervest HA, Vierhout ME. Trocar-guided mesh compared with conventional vaginal repair in recurrent prolapse. A randomized controlled trial. Obstet Gynecol. 2011;117:242–50.PubMedCrossRefGoogle Scholar
  42. 42.
    Dindo D, Demartines N, Clavien PA. Classification of surgical complications. Ann Surg. 2004;244:931–7.Google Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Division of Pelvic Medicine and Reconstructive Surgery, Department of UrologyUniversity of California Los AngelesLos AngelesUSA

Personalised recommendations