SUFU 2018: Characterization of Bacteria Identified on Explanted Mesh Slings Using Next-Generation Sequencing Techniques

Austin, TX ( Vaginal mesh sling kits for stress urinary incontinence are associated with several severe complications, including mesh extrusion, urinary problems, organ perforation, and vaginal scarring. Most complications are attributable to local pathology (e.g. erosion) or device misplacement (e.g. nerve entrapment). Ackerman and colleagues observed the delayed development of severe chronic pelvic pain, despite an apparently well-placed graft. They investigated the relationship between alterations in the mesh-associated microbiota with pain symptomatology and local inflammation.

Sling mesh segments were isolated from three groups of patients: 1) those with delayed-onset chronic pain, 2) those presenting mesh extrusions >1 cm, and 3) those with isolated urinary retention without pain. Explanted mesh segments were examined by culture-independent, species-specific PCR, denaturing gradient gel electrophoresis, and next-generation deep sequencing methods to detect bacterial communities on explanted mesh segments. 

Their result showed that exposed mesh segments were uniformly colonized with bacteria mirroring the vaginal microbiome. Beside that they detected bacterial species on explanted mesh from the group of patients with delayed-onset pain without mesh exposure that differed greatly from the vaginal species present at explanatation, suggesting an enrichment of specific pathogenic species able to survive on foreign bodies. This bacterial colonization was absent from patients without pain who underwent mesh removal to treat urinary retention. 

In conclusion there were numerous, distinct bacterial species present on the mesh removed from most subjects in group 1 that were not present in groups 2 and 3 nor in the vaginal microbiome. This suggests the need for further research to explore the relationship of these species and the associated subclinical infection and/or inflammation to delayed-onset chronic pain

Presented by: A. Lenore Ackerman, MD, PhD, Victoria Scott MD, Guo Liu PhD, Wenyuan Shi PhD and Shlomo Raz MD, Los Angeles, CA

Written by: Bilal Farhan, MD, Female Urology Fellow and Voiding Dysfunction, Department of Urology, University of California, Irvine at the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction Winter Meeting (SUFU 2018), February 27-March 3, 2018, Austin, Texas
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