Surgical interventions for the complications from synthetic mesh after midurethral sling surgery
Ji-Yeon Han (1), Mimi Oh (2)
(1) Pusan National University Yangsan Hospital, , South Korea, (2) Korea University Guro Hospital, Seoul, South Korea
Female stress urinary incontinence (SUI) is highly prevalent, and synthetic midurethral sling procedure is the most common type of anti-incontinence surgery. After the synthetic midurethral sling procedure, however, recognized complications include urinary storage and voiding symptoms, urethral, bladder and vaginal extrusion. The purpose of this study was to describe the evaluation and management of complications from synthetic mesh after surgery for SUI.
From March 2012 to April 2018, we retrospectively reviewed and analyzed the medical records of all patients who were referred to a tertiary referral centre for lower urinary tract symptoms and were diagnosed and underwent surgical intervention to manage the mesh-related complications after mid-urethral sling surgery.
A total 34 patients were diagnosed to mesh-related complications after midurethral sling surgery and underwent surgical managements. The complaints at evaluation were vaginal bloody spotting (n=15, 44.1%), recurrent cystitis (n=12, 35.3%), groin pain (n=2, 5.9%), voiding dysfunction (n=2, 5.9%), recurrence of SUI (n=2, 5.9%) and urgency or urgency incontinence (n=1, 2.9%). The mean time from midurethral sling surgery to first examination at a tertiary referral site was 5.7 ± 3.7 years (range, 0.08-15 years). All of the patients in this study, 21 patients (61.8%) had mesh perforations into the vagina, 5 patients (14.7%) into the urethra and 4 patients (11.8%) into the bladder. The most surgical intervention for treatment of their complication was the complete removal of the mesh by vaginal approach (n=31, 91.2%) (Figure 1). After surgical intervention, the symptoms related mesh perforations and infection were complete cured (n=30, 88.2%). However, groin pain and voiding dysfunction were persisted after mesh removal (n=2, 5.9%). After the removal of mesh, 3 patients (8..8%) had recurred SUI and underwent redo midurethral sling surgery.
These results suggest that mesh-related complications that are referred to tertiary centre are various and severe enough to require surgical intervention. This information is helpful in decision-making for surgical procedures to manage mesh complications.