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Long-Term Follow-up of Treatment for Synthetic Mesh Complications

Hansen, Brooke L. MD; Dunn, Guinn Ellen; Norton, Peggy MD; Hsu, Yvonne MD; Nygaard, Ingrid MD, MS

Female Pelvic Medicine & Reconstructive Surgery: May/June 2014 - Volume 20 - Issue 3 - p 126–130
doi: 10.1097/SPV.0000000000000084
Original Articles

Objectives: The objectives of this study are (1) to describe the presenting symptoms, findings, and treatment and (2) to describe the self-reported improvement and function at least 6 months after presentation in women presenting to 1 urogynecology division for complications associated with synthetic vaginal mesh.

Methods: Women evaluated between 2006 and 2011 were identified by diagnostic codes. We abstracted information from the medical record and attempted to contact all women to complete a follow-up telephone survey questionnaire consisting of several validated instruments.

Results: A total of 111 women were evaluated for complications associated with synthetic vaginal mesh. The mean interval from index surgery was 2.4 years. Of these, 84% were referred from outside hospitals. Index surgeries included vaginal mesh kits/vaginally placed mesh (47%), midurethral mesh slings (37%), abdominally placed vaginal mesh (11%), and vaginal mesh kit with concomitantly placed mesh sling (5%). The most common complications were extrusion (65%), contraction (17%), and chronic pelvic pain (16%). A total of 98 women underwent some type of treatment (85 surgical) by urogynecologists, pelvic pain specialists, or physical therapists. Eighty-four (76%) provided follow-up information at mean interval since presentation of 2.3 years. At follow-up, the mean (SD) Pelvic Floor Distress Inventory score was 98 (67), the mean (SD) EQ-5D index score was 0.69 (0.23), and 22% reported vaginal discharge, 15% vaginal bleeding or spotting, and 45% sexual abstinence due to problems related to mesh. A total of 71% reported being overall better, whereas 29% were the same or worse.

Conclusions: Two years after tertiary care level multidisciplinary treatment of vaginal mesh complications, many women still report symptoms that negatively impact their quality of life.

Two years after presentation to a tertiary care clinic for management of vaginal mesh complications, many women have persistent dysfunction.

From the Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT.

Reprints: Ingrid Nygaard, MD, MS, Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, University of Utah School of Medicine, Room 2B200, 50 North Medical Dr, Salt Lake City, UT 84132-0001. E-mail: Ingrid.Nygaard@hsc.utah.edu.

Reprints are not available.

The authors have declared they have no conflicts of interest

This investigation was supported by the University of Utah Study Design and Biostatistics Center, with funding in part from the National Center for Research Resources, the National Center for Advancing Translational Sciences, and the National Institutes of Health, through grant 8UL1TR000105 (formerly UL1RR025764).

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