The use of trocar-guided mesh kits for anterior vaginal wall prolapse (cystocele) repair is associated with mesh-related complications and other postoperative adverse events. Vaginal mesh exposure may induce a host-versus-implant immune response, which persists after surgery. The risk of a host-versus-implant reaction may be influenced by individual patient characteristics such as increasing age, parity, menopausal status, smoking, and somatic diseases. Relatively few studies have investigated the effects of smoking and other potential risk factors for mesh exposures after transvaginal mesh kit repair for pelvic organ prolapse.
This prospective study was designed to identify risk factors for mesh exposures after transvaginal mesh kit repair for pelvic organ prolapse. A secondary analysis was performed using combined patient data from 2 prospective multicenter studies for 353 women who underwent anterior prolapse mesh kit repair. The primary outcome of the present study, clinical host-versus-implant reactions 1 year after surgery, was assessed using a visual scale to rate inflammatory changes associated with the mesh. Mutlivariate logistic regession analysis was used to identify independent risk factors for mesh exposure at 1 year. Potential risk factors evaluated included age, parity, body mass index, menopausal status, smoking, and somatic inflammatory disease.
Participants were 353 patients who had anterior mesh kit repair for anterior pelvic organ prolapse. Patient mean age at surgery was 65.3 years. The index surgery was the first procedure done for prolapse in 63.5% (224/353) of the patients; all others had had prior prolapse surgery. Mesh exposures occurred in 8.6% (30/349) of the patients. In the adjusted data, there were significant associations with mesh exposures at 1 year for birth of more than 2 children (adjusted odds ratio [aOR], 2.64; 95% confidence interval [CI], 1.07–6.51), for smoking before surgery (aOR, 3.48; 95% CI, 1.18–10.28), and for systemic inflammatory disease such as rheumatoid arthritis (aOR, 5.11; 95% CI, 1.17–22.23). No significant association with clinical mesh exposures was found for age, body mass index, and menopausal status.
These findings indicate that smoking, multiparity, and systemic inflammatory disease may be risk factors for mesh exposures after trocar-guided anterior mesh kit repair for pelvic organ prolapse. Smoking is the only proposed risk factor amenable to intervention before surgery.
Division of Surgery and Urology, Department of Clinical Sciences Karolinska Institutet Danderyd Hospital, Stockholm, Sweden (C.E., A.H.), and Division of Obstetrics and Gynecology, Department of Clinical Sciences, Karolinska Institutet Danderyd Hospital, Stockholm, Sweden (C.F., D.A.); Department of Obstetrics and Gynecology, Västerås Hospital, Västerås Sweden (G.L.); Department of Obstetrics and Gynecology, South Hospital (M.E.), and Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden (D.A.).