This document focuses on the management of complications related to mesh used to correct stress urinary incontinence or pelvic organ prolapse. Persistent vaginal bleeding, vaginal discharge, or recurrent urinary tract infections after mesh placement should prompt an examination and possible further evaluation for exposure or erosion. A careful history and physical examination is essential in the diagnosis of mesh and graft complications. A clear understanding of the location and extent of mesh placement, as well as the patient’s symptoms and therapy goals, are necessary to plan treatment approaches. It is important that a treating obstetrician–gynecologist or other gynecologic care provider who seeks to revise or remove implanted mesh be aware of the details of the index procedure. Diagnostic testing for a suspected mesh complication can include cystoscopy, proctoscopy, colonoscopy, or radiologic imaging. These tests should be pursued to answer specific questions related to management. Given the diverse nature of complications related to mesh-augmented pelvic floor surgery, there are no universal recommendations regarding minimum testing. Approaches to management of mesh-related complications in pelvic floor surgery include observation, physical therapy, medications, and surgery. Obstetrician–gynecologists should counsel women who are considering surgical revision or removal of mesh about the complex exchanges that can occur between positive and adverse pelvic floor functions across each additional procedure starting with the device implant. Detailed counseling regarding the risks and benefits of mesh revision or removal surgery is essential and can be conducted most thoroughly by a clinician who has experience performing these procedures. For women who are not symptomatic, there is no role for intervention.
Number 694 • April 2017
Committee on Gynecologic Practice
American Urogynecologic Society
This Committee Opinion was developed by the American College of Obstetricians and Gynecologists’ Committee on Gynecologic Practice and the American Urogynecologic Society.
This document reflects emerging clinical and scientific advances as of the date issued and is subject to change. The information should not be construed as dictating an exclusive course of treatment or procedure to be followed.
Full-text document published concurrently in the April 2017 issue of Obstetrics & Gynecology.
Copyright April 2017 by the American College of Obstetricians and Gynecologists. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, posted on the Internet, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from the publisher.
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Management of mesh and graft complications in gynecologic surgery. Committee Opinion No. 694. American College of Obstetricians and Gynecologists. Obstet Gynecol 2017;129:e102–8.