Pain Persists in Nearly Half of Women After Vaginal Mesh Removal

By Reuters Staff

July 24, 2020

NEW YORK (Reuters Health) - Fewer than half of women who undergo partial or complete removal of mesh placed to repair pelvic organ prolapse (POP) have complete resolution of pain afterward, according to new findings in Urology.

POP develops in up to half of all parous women and is treated with surgery in 11%, the authors note. While repair with mesh may be more effective than native tissue repair, they add, resulting pain, vaginal mesh exposure and infection make its use "controversial." There is also debate over whether symptomatic mesh should be partly or completely removed.

Dr. Christian O. Twiss of the University of Arizona College of Medicine in Tucson and colleagues reviewed data on 92 women who underwent POP mesh removal at their center in 2009-2018. Pelvic/vaginal pain or dyspareunia was the primary indication in 78 patients. Other indications included mesh exposure in 38 (48.7%) and recurrent urinary tract infections in seven (11.5%).

Forty-five women (57.7%) had compete mesh removal. Intraoperative complications occurred in seven patients (8.9%), most commonly hemorrhage.

Painful symptoms resolved in 48.7%, improved in 37.2% and persisted in 11.5%; 2.6% of the women were lost to follow-up. Among those who underwent complete mesh removal, pain resolved in 46.7%, improved in 40.0% and persisted in 11.1%. Corresponding rates after partial removal were 51.5% resolved, 33.3% improved and 12.1% persisting. Pain resolution was not significantly different between the two groups.

Symptomatic prolapse recurred after mesh removal in 19 patients (24.4%), while 21 had recurrent urinary incontinence. Twenty-three patients needed additional reconstructive procedures after the mesh was removed.

Patients who had complete removal were numerically, but not statistically, more likely to have recurrent POP (31.1% vs. 15.2%, p=0.12).

The only factor significantly associated with risk of continued pain after mesh removal was concomitant excision of a midurethral sling (odds ratio 0.29, p=0.03).

"The difficulty in achieving complete resolution of pain symptoms following mesh removal is a common problem, and our pain resolution rates are highly consistent with the findings of other mesh removal series," Dr. Twiss and colleagues note.

"While recurrent POP rates appeared to be higher after complete mesh removal, this was not statistically significant," they add. "Nonetheless, all patients desiring mesh removal should be counseled carefully regarding expected symptom resolution and the possible increased risk of recurrent pelvic organ prolapse."

Dr. Twiss was not available for an interview by press time.

SOURCE: Urology, online July 13, 2020.