Assessment and initial management of mesh complications |
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| Institution: | Obstetric and Gynecologic Department, Center for Medical Education and Clinical Research “Norberto Quirno” Universitary Hospital, Galván 4102, C1431 Buenos Aires, Argentina;Obstetric and Gynecologic Department, Fernandéz Hospital, Buenos Aires, Argentina;Department of Obstetrics and Gynecology, Baylor College of Medicine, 6651 Main St., Ste. F1020, Houston, TX 77030;Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI;Department of Obstetrics and Gynecology, Herlev and Gentofte University Hospital, Borgmester Ib Juuls Vej 1, Herlev 2730, Denmark;Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark;The Third XiangYa Hospital of Central South University, Changsha, Hunan Province, China;Chevidence Lab Child & Adolescent Health, Children’s Hospital of Chongqing Medical University, Chongqing, China;National Clinical Research Center for Child Health and Disorders, Chongqing, China;School of Public Health, Lanzhou University, Lanzhou, China;Chevidence Lab Child & Adolescent Health, Children’s Hospital of Chongqing Medical University, Chongqing, China;National Clinical Research Center for Child Health and Disorders, Chongqing, China;Children’s Hospital of Chongqing Medical University, Chongqing, China;Department of Obstetrics and Gynecology, Carmel Medical Center, Haifa, Israel;Ruth and Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa, Israel;Clinical Serology and Virology Laboratory, Carmel Medical Center, Haifa, Israel;Department of Obstetrics and Gynecology, Carmel Medical Center, Haifa, Israel;Ruth and Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa, Israel;Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Haifa, Israel;Department of Obstetrics and Gynecology, Carmel Medical Center, Haifa, Israel;Ruth and Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa, Israel;Department of Neonatology, Carmel Medical Center, Haifa, Israel;Ruth and Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa, Israel;Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Duke University, Ste. 205, 2608 Erwin Rd., Durham, NC 27705;Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Vanderbilt University, Nashville, TN;Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Wake Forest University, Winston-Salem, NC;Division of Population and Community Health, Department of Obstetrics and Gynecology, Duke University, Durham, NC;Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Indiana University, Indianapolis, IN;Division of Complex Family Planning, Department of Obstetrics and Gynecology, The University of New Mexico, Albuquerque, NM |
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| Abstract: | Synthetic polypropylene mesh have been used in the surgical management of pelvic organ prolapse (POP) and stress urinary incontinence (SUI) since 1990's. However, following patients'-led campaign with concerns regarding the complications associated with mesh, their use in surgical management of SUI and/or POP has been controversial. Complications associated with these mesh implants include chronic pain, vaginal mesh exposure, perforation into organs, infections and sinus tract formation. In April, 2019, the NICE guideline (NG123) provided an evidence review for management of mesh complications. Following Independent Medicine and Medical Devices Safety Review (IMMDS) publication in 2020, a network of specialized complex mesh centres across the UK have been set up. All patients with mesh-related complications should receive specialist multidisciplinary care in these centres. In this review, we outline the assessment and initial management of patients who present with mesh-related complications. Assessment and management options should be tailored per individual cases. Assessment includes clinical assessment and investigations including radiological imaging. All management options including no treatment, conservative, medical and surgical treatment, including minimally invasive treatment with the pros and cons of every option should be offered and patient should be actively involved in their decision making in a “shared-decision making” manner. |
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| Keywords: | Mesh complications mesh excision mesh removal mid-urethral tape transvaginal mesh |
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