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Pathologic Evaluation of Explanted Vaginal Mesh: Interdisciplinary Experience From a Referral Center

Smith, Tovia M. MD*; Smith, Steven C. MD, PhD; DeLancey, John O. MD*; Fenner, Dee E. MD*; Schimpf, Megan O. MD*; Roh, Michael H. MD, PhD; Morgan, Daniel M. MD*

Female Pelvic Medicine & Reconstructive Surgery:
doi: 10.1097/SPV.0b013e31829996e2
Original Articles
Abstract

Objectives: In light of vaginal mesh safety concerns, we reviewed our institutional experience with analytic processes and pathologic findings of explanted vaginal mesh to identify problems and opportunities to facilitate improved documentation and research.

Methods: We reviewed gross and microscopic pathology reports and archival slides of explanted mesh specimens from January 2010 through February 2012. Specimen requisition clinical history, number of mesh specimens per case, and type of examination (gross or histologic) were abstracted from pathology records using the initial search word “mesh”.

Results: One hundred two cases were reviewed. Explanted mesh specimens included tissue in 97%. Forty-eight percent of these cases were submitted for histopathologic evaluation (as opposed to gross examination only). Specimen requisitions listed clinical history as pain (28.4%), vaginal mesh erosion (24.5%), erosion (17.6%), urinary retention (5.9%), and infection (2.9%). When no history was provided (24.5%), the case was more frequently submitted for histologic examination (74% vs 41%, P = 0.05). In all but 2 cases, the mesh material was polypropylene; no requisition mentioned this information. Gross descriptions of mesh varied significantly; in 18% of the cases, mesh was inaccurately described as “metallic”. No cases of neoplasm were diagnosed histologically; all tissue diagnoses described benign reactive processes.

Conclusions: Our experience suggests that either gross or histopathologic examination is appropriate for mesh explants. Documentation of clinical history, mesh product, and material was frequently incomplete and associated with increased submission of tissue for histologic examination and inaccurate gross impression of material type. We recommend improved documentation to aid pathologic examination and enable future pathophysiologic study of mesh complications.

In Brief

Review of interdisciplinary experience with pathologic evaluations of explanted vaginal mesh specimens highlights the need for greater communication between surgeons and pathologists to ensure accurate documentation, diagnosis, and opportunity for study of the pathophysiology of mesh complications.

Author Information

From the *Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, and †Department of Pathology, University of Michigan Health System, Ann Arbor, MI.

Reprints: Tovia Martirosian Smith, MD, L4000 Women’s Hospital, 1500 E Medical Center Dr, SPC 5276, Ann Arbor, MI 48109. E-mail: toviasmith@gmail.com.

Tovia M. Smith and Steven C. Smith contributed equally to this work.

Disclosures: A preliminary analysis of this work was presented at the 2012 Scientific Meeting of the American Urogynecologic Society, Chicago, IL.

No funding was received for this work.

The authors have declared they have no conflicts of interest.

© 2013 by Lippincott Williams & Wilkins