October 9, 2012 (Chicago, Illinois) — Removal of vaginal mesh results in complete resolution of pain and dyspareunia in 45.6% of patients. Mesh erosion can be found in the bladder, bowel, or other regions of the vagina, and, therefore, these areas should be evaluated during mesh removal.
Erin C. Crosby, MD, from the University of Michigan in Ann Arbor, presented her paper at the American Urogynecologic Society (AUGS) 33rd Annual Scientific Meeting. Dr. Crosby explained that during the past 5 years, the University of Michigan tertiary center where she works has seen a 10-fold increase in the number of vaginal mesh removals. She added that "the number of procedures…we perform at our institution continues to increase each year."
The study was designed to review the institution's experience with vaginal mesh removal. The researchers performed a retrospective chart review of all patients having vaginal mesh removal.
The study included 57 women who had surgery for complications related to vaginal mesh between January 2010 and December 2011. The mean age of the patients was 58 and mean parity was 2. The mean length of follow-up was 6 months.
Dr. Crosby stated, "About half of our patients had more than 1 complaint at the time of presentation." Presenting symptoms included mesh exposure (49%), pain (59%), and dyspareunia (49%). Before presenting to the tertiary institution, many women had undergone 1 (15 patients) or more (9 patients) attempts at mesh removal.
Mesh was removed from the anterior compartment in 70% of women, the posterior compartment in 36% of women, and the apex in 5% of women. During surgery, mesh was encountered unexpectedly in many patients: in a second area of the vagina (7%), in the bladder (1.7%), and in the bowel (3.5%).
The woman who had mesh erosion in the bladder required a second surgery.
In 33 of the 57 patients included in the study, the mesh was not lying flat or tension free. A member of the audience acknowledged the same experience, stating, "As someone who removes mesh almost weekly... there is often a band or it is balled or folded."
At University of Michigan, 71% of women receiving mesh removal had significant improvement or resolution of pain. Mesh exposure was resolved in 96% of patients. However, many patients reported persistent pain (50%) and dyspareunia (25%) after mesh removal.
Patient Expectations After Mesh Removal
Dr. Crosby emphasized that it is important to manage postoperative expectations. "Mesh removal is part of a process of pain relief," she stated, noting that there are probably aspects of the mesh contributing to patient symptoms that we have not yet recognized.
Dr. Crosby acknowledged that the study was limited by the relatively short follow-up and the fact that outcomes for total and partial mesh removal were combined. She explained that in recounting mesh removal procedures, it is often difficult to describe how much mesh has been removed.
Lieschen H. Quiroz, MD, from the University of Oklahoma in Oklahoma City, spoke after the presentation. She thanked Dr. Crosby and her colleagues for "a great study." Dr. Quiroz then went on to explain that despite the frequent need for mesh removal when patients experience complications, there is currently little to no literature guiding physicians on how to counsel patients about expectation after mesh removal.
Dr. Crosby and Dr. Quiroz have disclosed no relevant financial relationships.
American Urogynecologic Society (AUGS) 33rd Annual Scientific Meeting. Paper Presentation 30. Presented October 5, 2012.
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Cite this: Vaginal Mesh Removal Difficult and May Not Relieve Pain - Medscape - Oct 09, 2012.