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Jewish Doctors Network Transvaginal Mesh Update

Speak to our female Social Worker Regarding your Transvaginal Mesh 1 877 522 2123  Jewish Doctors Network Community Resource News
SAVANNAH, GA. — Transvaginal mesh Surgical intervention is most often required in women presenting with symptomatic mesh erosion, pain, following vaginal mesh placement for the treatment of pelvic organ , according to the results of two retrospective studies.

In one study presented at the annual meeting of the Society of Gynecology  Surgeons, Dr. Beri M. Ridgeway, of the department of obstetrics and gynecology at the Cleveland Clinic Foundation, and her colleagues retrospectively reviewed electronic medical records to identify women who required surgical intervention for complications related to mesh kit use for the treatment of pelvic organ prolapse between 2005 and 2007.
 

A total of 19 women were identified (mean age 60 years). Of these, 89% had mesh placed as their primary surgery for pelvic organ prolapse.

Most patients (89%) had either anterior or total Prolift (Ethicon Inc.) placed. Removal indications included symptomatic mesh erosion (63%), recurrent pelvic organ prolapse (42%), chronic pain (32%), and dyspareunia (32%). Most patients cited multiple indications.

The median time between surgery and presentation for complications was 17 weeks, and 84% failed medical management of their complication. Three patients already had undergone partial transvaginal mesh excision at another institution.

The surgical approach was vaginal in 79% of patients. The median operative time–including concomitant repair of pelvic organ prolapse–was 190 minutes, and the median estimated blood loss was 175 mL.

No intraoperative complications occurred. The mean postoperative stay was 2 days.

Postoperatively, one patient had a rectovaginal hematoma, subsequently requiring transfusion. Three patients suffered from urinary tract infections.

Roughly three-quarters (79%) of the women were available for telephone follow-up. The median follow-up time was 33 weeks. The women were asked to re port their pain using a 10-point scale, percentage of improvement compared with pre implant symptoms, continued symptoms, and if sexual activity was resumed.

The median pain score at follow-up was 0, and 87% of the women reported significant improvement in their initial complaint. At follow-up, no patient reported abnormal discharge or vaginal bleeding. One-fifth of the women reported recurrent pelvic organ prolapse. A third reported being sexually active.

Most of the women (87%) said that they would not have had the original mesh placement if they knew what they know now. Almost all (93%) were satisfied with surgical treatment of their complications.

Dr. Ridgeway reported that she did not have any relevant financial relationships to disclose.

In a second study presented at the meeting jointly sponsored by the American College of Surgeons, Dr. Rebecca U. Margulies, a fellow in female pelvic medicine and her colleagues conducted a retrospective chart review in which they queried the surgical billing records of all reconstructive pelvic surgeons at the University of Michigan for the excision of any vaginal graft material between 1997 and 2007.

Women who had undergone midurethral sling placement only or women in whom recurrent prolapse was the only complaint were excluded.

Thirteen cases were identified that occurred between August 2005 and November 2007.

All but one of the women had a symptomatic mesh exposure. The chief complaint among the women (median age 59 years) was vaginal pain, which nine women reported. One patient also had a vesicovaginal fistula. Another had a rectovaginal fistula.

Another patient had recurrent prolapse, in addition to other symptoms. Another woman reported bothersome vaginal discharge. Seven women were sexually active, with six reporting dyspareunia at the time of presentation.

The mean time between Transvaginal mesh placement and presentation for symptoms was 8 months. Seven women had prior  conditions and five underwent hysterectomy concurrent with mesh placement. One of these women also had a pelvic Two patients had pain syndromes without mesh exposure. Five women had undergone prior attempts to excise the mesh.

All of the women underwent removal excision or transection of vaginal mesh placed to treat prolapse. The mean operating time was 71 minutes. Mesh folding was found intraoperatively in nine women. No intraoperative complications occurred. All meshes were from the Apogee/Perigee system (American Medical Systems), as confirmed by operative report.

Six patients required a second  Transvaginal Mesh surgery. There were no recurrent exposures during a median of 26 weeks of follow-up.

Of the nine women who originally presented with pain, seven had resolution. However, three of five women who were sexually active still complained of dyspareunia.

Dr. Margulies reported that she had no relevant financial relationships to disclose.

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