High complication rate identified in sacrocolpopexy patients attributed to silicone mesh.
OBJECTIVE
To report on our experience using a preconfigured Y-shaped silicone-coated polyester mesh and polypropylene mesh for vaginal vault suspension. A variety of materials have been used for both open and laparoscopic sacrocolpopexy in the management of vaginal vault prolapse. Recently, a preconfigured Y-shaped silicone-coated polyester mesh was introduced to facilitate the vaginal cuff suspension to the sacrum.


METHODS
We reviewed the data of 45 consecutive patients who underwent abdominal (n = 28) or laparoscopic (n = 17) sacrocolpopexy. Of the 45 patients, 21 underwent silicone mesh suspension of the vaginal cuff to the anterior sacrum, with a mean follow-up of 23 months (range 16 to 41). A comparative analysis was performed of 24 patients who underwent the same procedure with polypropylene mesh.


RESULTS
Of the 21 patients in the silicone group, 5 (23.8%) have had a major complication (four vaginal mesh erosions and one mesh infection) after a median follow-up of 9.5 months (range 4 to 20). The presenting symptoms were persistent or new vaginal discharge and/or nonspecific pelvic pain. One patient underwent successful removal of the mesh transvaginally, but the rest required abdominal exploration. To date, the 24 patients who underwent vaginal cuff suspension with polypropylene mesh have had no vaginal mesh extrusions or infections, with a mean follow-up of 12 months (range 1 to 38).


CONCLUSIONS
Silicone-coated polyester mesh has recently been associated with a high rate of vaginal erosion when used as a transvaginal suburethral sling. Our experience specifically with vaginal vault suspension corroborates this. We have abandoned the use of silicone mesh because of the unacceptably high extrusion rate and presently use polypropylene mesh.
Govier
Fred E
FE
Department of Surgery, Continence Center, Virginia Mason Medical Center, Seattle, Washington 98111, USA. urofeg@vmmc.org
Kobashi
Kathleen C
KC
Kozlowski
Paul M
PM
Kuznetsov
Dimitri D
DD
Begley
Sean J
SJ
McGonigle
Kathryn F
KF
Muntz
Howard G
HG
D000368:Aged; D000369:Aged, 80 and over; D020099:Coated Materials, Biocompatible / Q000009:adverse effects; D020878:Device Removal; D005260:Female; D006801:Humans; D008875:Middle Aged; D011126:Polypropylenes; D012086:Reoperation; D012828:Silicones; D013526:Surgical Mesh / Q000009:adverse effects*; D013519:Urogenital Surgical Procedures / Q000009:adverse effects; D014596:Uterine Prolapse / Q000601:surgery*
D020099:Coated Materials, Biocompatible; D011126:Polypropylenes; D012828:Silicones