Beyond the complications: medium-term anatomical, sexual and functional outcomes following removal of trocar-guided transvaginal mesh. A retrospective cohort study

• Published in: International Urogynecology Journal 2012-10, Vol.23 (10), p.1391-1396
• Main Authors: Jeffery, Stephen T., Nieuwoudt, Andri
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Cohort Studies; Device Removal; Dyspareunia - epidemiology; Female; Follow-Up Studies; Gynecologic Surgical Procedures - adverse effects; Gynecologic Surgical Procedures - instrumentation; Gynecologic Surgical Procedures - methods; Gynecology; Humans; Incidence; Longitudinal Studies; Medicine; Medicine & Public Health; Middle Aged; Original Article; Pelvic Organ Prolapse - epidemiology; Pelvic Organ Prolapse - surgery; Pelvic Pain - epidemiology; Recurrence; Reoperation; Retrospective Studies; Surgical Instruments; Surgical Mesh - adverse effects; Treatment Outcome; Urinary Incontinence, Stress - epidemiology; Urology
• ISSN: 0937-3462; 1433-3023
• DOI: 10.1007/s00192-012-1746-7

Introduction and hypothesis The aims of this study were to assess the anatomical, sexual and functional outcomes of women undergoing surgical intervention for complications of the trocar-guided transvaginal mesh (TVM) procedure. Methods This was a retrospective analysis of a clinical database of women who had developed a complication following a TVM procedure. This included dyspareunia, mesh erosion, urinary symptoms, mesh contraction and prolapse recurrence. Pre- and post-operatively, we assessed the women for prolapse, stress incontinence, urgency, defecatory difficulty, digitation, pain, dyspareunia and apareunia. We also recorded the Pelvic Organ Prolapse Quantification (POP-Q) score. The TVM was removed and a Biodesign graft was used in the majority of cases to prevent further prolapse. Follow-up was at 6 weeks, 6 months, 1 and 2 years. Results In our cohort of 21 women, 18 required surgery for pain and/or dyspareunia; 20 women had reached the 6-week follow-up at the time of analysis. At 6 weeks, two women still had pain and required a second intervention. Fifteen women had reached a 6-month follow-up and only one woman had persistent pain requiring repeat surgery. Of the 15 women, 7 were sexually active and in 6 cases the dyspareunia had resolved completely with 1 woman retaining an element of pain at intercourse. Six women had been seen at 12 months and all four of the sexually active women had no dyspareunia. There were no symptoms relating to prolapse in any of the women at 6 weeks, 6, 12 or 24 months. Conclusions We report satisfactory outcomes following removal of a complicated TVM kit.