An update on research and outcomes in surgical management of vaginal mesh complications

ABSTRACT

Introduction: Stress urinary incontinence and pelvic organ prolapse are major quality of life conditions affecting millions of individuals. Transvaginal mesh materials have been proposed to supplant native tissue repairs. However, these materials have opened a new field, meshology, devoted to the management of mesh complications.

Areas covered: This review highlights some of the recent developments in this subspecialty which often requires a multidisciplinary approach. With better imaging, the preoperative assessment of mesh complications has been enhanced. Specialized centers with high volumes are best suited to handle these challenging patients who fear the many risks of mesh removal and the uncertainties of their clinical status after the removal procedure(s). However, despite a better classification system recommended by specialized societies, the multidimensional outcome of these repair procedures will require the adoption of outcome tools which can cover several domains such as urinary incontinence, pelvic pain, dyspareunia, bladder infections, to name a few.

Expert opinion: The surgical approach to mesh removal is also evolving with some experts recommending complete removal while others prefer more selective excision. Finally, the long-term outcome of these mesh removal procedures is not yet fully known.

KEYWORDS:

• Mid-urethral sling
• prolapse
• stress urinary incontinence
• complications
• vaginal mesh
• FDA notification; mesh litigation

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.