Risk factors and management of vaginal mesh erosion after pelvic organ prolapse surgery

Abstract

Objective: Mesh erosion is a serious and not uncommon complication in women undergoing vaginal mesh repair. We hypothesized that mesh erosion is associated with the patient’s comorbidities, surgical procedures, and mesh material. The aims of this study were to identify the risk factors and optimal management for mesh erosion. Materials and Methods: All women who underwent vaginal mesh repair from 2004 to 2014 were retrospectively reviewed. Data on patients’ characteristics, presenting symptoms, treatment and outcomes were collected from their medical records. Results: A total of 741 women underwent vaginal mesh repairs, of whom 47 had mesh erosion. The median follow-up period was 13 months (range 3–84 months). Another nine patients with mesh erosion were referred form other hospitals. Multivariate analysis revealed that concomitant hysterectomy (odds ratio 27.02, 95% confidence interval 12.35–58.82; p < 0.01) and hypertension (odds ratio 5.95, 95% confidence interval 2.43–14.49; p < 0.01) were independent risk factors for mesh erosion. Of these 56 women, 20 (36%) were successfully treated by conservative management, while 36 (64%) required subsequent surgical revision. Compared with surgery, conservative treatment was successful if the size of the erosion was smaller than 0.5 cm (p < 0.01). Six patients (17%) had recurrent erosions after primary revision, but all successfully healed after the second surgery. Conclusion: Concomitant hysterectomy and hypertension were associated with mesh erosion. In the management of mesh erosion, conservative treatment can be tried as the first-line treatment for smaller erosions, while surgical repair for larger erosions. Recurrent erosions could happen and requires repairs several times.

Keywords

• mesh erosion
• pelvic organ prolapse
• postoperative complication
• surgical mesh
• vaginal surgery