ABSTRACT: Between 2008 and 2010, the Food and Drug Administration (FDA) received nearly 3000 reports of complications associated with the use of surgical mesh devices for pelvic organ prolapse (POP). More than half were associated with prolapse repair. Complications with mesh include dyspareunia, chronic pelvic pain, and mesh erosion or retraction; some of these are not amenable to conservative management and require surgery, which is generally partial or complete excision of the mesh. Removal of mesh may increase the risk of prolapse recurrence.
The aim of this retrospective cohort study was to assess preoperative and postoperative anatomical and functional outcomes after mesh excision. The POP quantification (POP-Q) system was used to evaluate anatomical outcomes.
Prolapse recurrence was defined as stage II or higher-stage prolapse on the POP-Q system and/or need for additional prolapse surgery and/or postoperative placement of use of a pessary for prolapse reduction. Functional outcomes after mesh removal were determined using the pelvic floor distress inventory and pelvic floor impact questionnaire scores.
A total of 71 patients met study criteria; 63%(44/70) underwent partial mesh excision, and 37% (26/71) underwent total mesh removal. Of the 71 patients, 19 (27%) had preoperative prolapse, and 27 (38%) underwent concomitant native tissue prolapse repair. Overall change in POP-Q stage among the women who had total removal (median, −1 [−3 to 0]; P = 0.006) was more advanced than in women with partial removal (median, 0 [−1 to 2]) at 1 year postoperatively. None of the patients required a second surgery; 1 (1.4%) was treated with a pessary. Six months after mesh excision, there was a significant improvement in total pelvic floor distress inventory and pelvic floor impact questionnaire scores (P < 0.05). Although sexual activity rates were not increased after mesh excision, dyspareunia improved significantly with removal (P = 0.034).
These data show that total and partial mesh excision is associated with POP retreatment rates of 1.4% in this patient population. Mesh excision is generally safe and results in significantly improved functional outcomes.
Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Indiana University Health, Indianapolis, IN