SUFU 2018: Meshing Around: Long-Term Outcomes Following Vaginal Reconstructive Surgery with Synthetic Mesh Augmentation

Austin, TX ( Dr. Margaret Knoedler and colleagues presented the 5-30 year outcomes following vaginal reconstructive surgery with synthetic mesh augmentation. The primary outcome was reoperation for mesh-related complication. Factors associated with mesh-related reoperation on univariate analysis with p-value<.2 were included in a backward linear regression model. Secondary outcomes included rates of mesh-related complications, overall reoperation rate, and current symptoms and satisfaction.

This was retrospective chart review of patients who underwent vaginal prolapse surgery with synthetic mesh between May 1991 and October 2010 at a single academic institution. Details regarding past medical and surgical history, index surgery performed, perioperative complications, and relevant subsequent operations were abstracted; current symptoms, signs and patient satisfaction were ascertained from written surveys and pelvic exams when available. Descriptive analyses were performed to characterize the sample. Results: Among 804 potential patients identified, 158 patients were eligible for inclusion. Overall, 33/158 (21%) women underwent mesh-related reoperation; associated factors are outlined in Table 1. The rate of mesh-related complication was 34%(n=54); 30%(48) had mesh extrusion into the vagina and 1% had mesh erosion into the bladder(1) or rectum(1). Among 43 questionnaires received, 74 %(32) report symptoms are better, 9%(4) are the same, and 16%(7) are worse. Regarding surgical satisfaction, 42% (18) are very satisfied, 28 %(12) somewhat satisfied, 14%(6) somewhat unsatisfied, and 16%(7) very unsatisfied. 

The authors reported when followed for up to 25 years, almost one third of patients who had a mesh augmented transvaginal repair of prolapse required a subsequent operation. Over 20% of patients required reoperation for a mesh related complication. Younger women, women with apical mesh placed, and women who experienced intraoperative urinary tract injury were more likely to require reoperation. 

Presented by: Margaret Knoedler, MD

Co- Authors: Hayley Barnes MD, Elizabeth Meller BS, Caroline Kieserman-Shmokler MD, Dobie Giles MD, MS, Christine Heisler MD, MS, Heidi Brown MD, MAS and Sarah McAchran MD, Madisonm WI

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