Clinical Outcomes After Operative Management of Complications From
Complications from transvaginal mesh placed for prolapse often require operative management. Although the current literature discusses mesh complications including pain, mesh erosion or exposure, and infection, there is little literature regarding the outcomes after surgical removal or revision of mesh. And most of these studies are based on retrospective chart review and used subjective measures without standardized questionnaires. The purpose of this prospective study is to describe the outcomes of vaginal mesh removal using standard questionnaires before and after surgery.
After obtaining approval from the Loma Linda University Medical Center Institutional Review Board, a prospective study was conducted among female patients who are undergoing removal of vaginal mesh. All the patients were referred to our tertiary care center with various indications. The study period was between January 2013 and May 2014. Demographics, relevant medical history, previous surgical history, and presenting symptoms were obtained. The surgery was performed vaginally for complete removal of mesh. Pre- and postoperative assessment included standard questionnaires with PFDI-20 (POPDI-6, CRAID-8,UDI-6), PFIQ-7, PISQ-12, PHQ-9, and pain scale. And PGIC (Patient Global Impression of Change) was used as a primary outcome. Comparative statistics were performed using paired t-test or non parametric Wilcoxon test with significance at p<.05.
Twenty patients participated during the study period and two patients lost follow up. Their mean age was 62.3 years (range 43-78), with a mean follow-up of 9 months (range 3-22) from mesh removal surgery. All subjects reported vaginal pain as one of the chief complaints and denied history of chronic pelvic pain before mesh placement. And other presenting symptoms include overactive bladder (OAB), urinary retention, and recurrent pelvic organ prolapse (POP). Of the 18 patients, 4 had concurrent mid-urethral sling with vaginal mesh and 12 had vaginal mesh exposure confirmed during the physical examination. After mesh removal, half patients (n=9) markedly improved overall (“better” or “a great deal better” on PGIC), whereas 5 (27%) had “no change” or “almost the same” on PGIC. Pain improved significantly (p=0.01) with complete resolution in 8 (44%) patients. When quality of life and symptoms scores were compared before and after surgery, Pelvic Organ Prolapse Impact Questionnaire (POPIQ-7) scores showed statistically significant improvement (Table1).
A quarter of patients reported no overall improvement after vaginal mesh removal. However, in majority of patients surgery appears to be effective in improving presenting symptoms with significant improvement in quality of life from vaginal and pelvic symptoms