AUA 2019: The Management and Efficacy of Surgical Outcomes used for Erosive Mesh in the Urethra and Bladder
They did a systematic review using (PUBMED and MEDLINE) for clinical studies involving combined outcomes for mesh erosion in humans. Databases were searched from the time of inception through May 2016 for articles reporting surgical techniques to remove eroded mesh. Key terms searched were : mesh erosion in bladder, management of bladder mesh erosions, "bladder mesh erosions, "management of mesh erosions", "mesh erosion into the bladder", "mesh erosions of the bladder", "management of mesh erosions in the bladder", "mesh erosions", "bladder erosions due to mesh", urethral erosion, and "transurethral resection of bladder erosion.
There were 754 articles were found, 654 articles were excluded due to ineligibility criteria. A total of 100 articles were included in this systematic review, with a total of 177 patients analyzed. Of the patients who underwent mesh removal, 18 were abdominal, 40 were transvaginal, 119 were cystoscopic mesh removal. For these techniques the percentage of patients who felt their symptoms were resolved compared to those unresolved were abdominal (78% vs. 22%); transvaginal (63% vs. 37%) and cystoscopic bladder (55% vs. 44%) and cystoscopic urethra (39% vs. 22%). Mesh removal was successful 85% in abdominal, 100% in transvaginal, 83% in endoscopy/cystoscopy and 85% in cystoscopy bladder.
They concluded that the abdominal and transvaginal approach to mesh removal appeared to have greater success at removing mesh then the cystoscopic approaches. For mesh eroded into the urethra, a transvaginal approach had better resolution of symptoms and less intervention. For mesh eroded into the bladder, abdominal and cystoscopic approaches for bladder mesh erosion had similar symptom resolution but abdominal approach required less retreatment.
Presented by: Mitali Kini, Weill Cornell Medicine, New York, New York
Co-Authors: Dominique Thomas, Mitali Kini*, Tirsit Asfaw, Bilal Chughtai,
Written by: Bilal Farhan, MD, Clinical Instructor, Female Urology and Voiding Dysfunction, Department of Urology, University of California, Irvine @BilalfarhanMD at the American Urological Association's 2019 Annual Meeting (AUA 2019), May 3 – 6, 2019 in Chicago, Illinois