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Exploring Predictors of Mesh Exposure After Vaginal Prolapse Repair

Sirls, Larry T. MD*; McLennan, Gregory P. MD; Killinger, Kim A. MSN; Boura, Judith A. MS*; Fischer, Melissa MD*; Nagaraju, Pradeep MD*; Peters, Kenneth MD*

Female Pelvic Medicine & Reconstructive Surgery: July/August 2013 - Volume 19 - Issue 4 - p 206–209
doi: 10.1097/SPV.0b013e318298b381
Original Articles

Objectives: To evaluate clinical, demographic, and surgical factors that may be associated with mesh exposure after vaginal repair of pelvic organ prolapse (POP).

Methods: Records of women who underwent POP repair with Elevate or Prolift were retrospectively reviewed. Body mass index (BMI), prolapse grade, smoking history, diabetes, steroid and estrogen use, parity, compartment repaired, concurrent hysterectomy, operative time, postoperative pain, change in hemoglobin (ΔHgb) and other characteristics were evaluated for associations with mesh exposure.

Categorical variables were examined using Pearson χ2 test where appropriate, or the Fisher exact test was used. The continuous variables were examined using Wilcoxon rank tests. A multivariable logistic regression analysis was completed to examine predictors of mesh exposure. All analyses used SAS for Windows version 9.2 (Cary, NC).

Results: Three hundred thirty-five women underwent repair from 2006 to 2011. Vaginal mesh exposure was identified in 27 (8.1%) of the 335 women. Patients with exposure had longer median follow-up than the group with no exposure (357 vs 145 days; P = 0.0003). The median time to exposure was 96 days (15–1129 days). Mesh exposure was associated with lower BMI (25.2 ± 2.5 vs 27.4 ± 5.1; P = 0.020) and greater ΔHgb (−3.7 ± 1.7 mg/dL vs −2.5 ±1.3; P = 0.0011). Change in hemoglobin decreased over time (P = 0.0005). Exposure rates also decreased over time (17% in 2005 to 12% in 2006, then 5%–8% in 2006–2011) but were not statistically significant (P = 0.49).

Conclusions: In this study, vaginal mesh exposure was only associated with ΔHgb and lower BMI.

Mesh exposure, with an overall rate of 8.1%, was associated with an increased hemoglobin loss and lower Body Mass Index.

From the *William Beaumont School of Medicine, Oakland University, Royal Oak, MI; and †Department of Urology, William Beaumont Hospital, Royal Oak, MI.

Reprints: Gregory P. McLennan, MD, William Beaumont Hospital, 3535 West 13 Mile Rd, Royal Oak, MI 48073. E-mail: grmc15@gmail.com; Gregory.mclennan@beaumont.edu.

The authors have declared they have no conflicts of interest.

Funding was provided by Ministrelli Program for Urology Research and Education, and a grant was received from American Medical Systems.

© 2013 by Lippincott Williams & Wilkins