title: Evaluation and management of complications from synthetic mesh after pelvic reconstructive surgery: a multicenter study.
abstract: OBJECTIVE
  The purpose of this study was to describe the evaluation and management of synthetic mesh-related complications after surgery for stress urinary incontinence (SUI) and/or pelvic organ prolapse (POP).
  
  
  METHODS
  We conducted a multicenter, retrospective analysis of women who attended 4 US tertiary referral centers for evaluation of mesh-related complications after surgery for SUI and/or POP from January 2006 to December 2010. Demographic, clinical, and surgical data were abstracted from the medical record, and complications were classified according to the Expanded Accordion Severity Classification.
  
  
  RESULTS
  Three hundred forty-seven patients sought management of synthetic mesh-related complications over the study period. Index surgeries were performed for the following indications: SUI (sling only), 49.9%; POP (transvaginal mesh [TVM] or sacrocolpopexy only), 25.6%; and SUI + POP (sling + TVM or sacrocolpopexy), 24.2%. Median time to evaluation was 5.8 months (range, 0-65.2). Thirty percent of the patients had dyspareunia; 42.7% of the patients had mesh erosion; and 34.6% of the patients had pelvic pain. Seventy-seven percent of the patients had a grade 3 or 4 (severe) complication. Patients with TVM or sacrocolpopexy were more likely to have mesh erosion and vaginal symptoms compared with sling only. The median number of treatments for mesh complications was 2 (range, 1-9); 60% of the women required ≥2 interventions. Initial treatment intervention was surgical for 49% of subjects. Of those treatments that initially were managed nonsurgically, 59.3% went on to surgical intervention.
  
  
  CONCLUSIONS
  Most of the women who seek management of synthetic mesh complication after POP or SUI surgery have severe complications that require surgical intervention; a significant proportion require >1 surgical procedure. The pattern of complaints differs by index procedure.
authors.affiliation: Center for Urogynecology and Reconstructive Pelvic Surgery, Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Sara
authors.initials: S
authors.lastname: Abbott
authors.affiliation: Center for Urogynecology and Reconstructive Pelvic Surgery, Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Cecile A
authors.initials: CA
authors.lastname: Unger
authors.affiliation: Advanced Urogynecology and Pelvic Surgery, The Christ Hospital, Cincinnati, OH.
authors.forename: Janelle M
authors.initials: JM
authors.lastname: Evans
authors.affiliation: Department of Urogynecology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Karl
authors.initials: K
authors.lastname: Jallad
authors.affiliation: Department of Urogynecology, Women & Infants Hospital of Rhode Island, Providence, RI.
authors.forename: Kevita
authors.initials: K
authors.lastname: Mishra
authors.affiliation: Advanced Urogynecology and Pelvic Surgery, The Christ Hospital, Cincinnati, OH.
authors.forename: Mickey M
authors.initials: MM
authors.lastname: Karram
authors.affiliation: Department of Urogynecology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Cheryl B
authors.initials: CB
authors.lastname: Iglesia
authors.affiliation: Department of Urogynecology, Women & Infants Hospital of Rhode Island, Providence, RI.
authors.forename: Charles R
authors.initials: CR
authors.lastname: Rardin
authors.affiliation: Center for Urogynecology and Reconstructive Pelvic Surgery, Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, OH. Electronic address: barberm2@ccf.org.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Barber
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008875:Middle Aged; D056887:Pelvic Organ Prolapse / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis / Q000601:surgery; D019651:Plastic Surgery Procedures; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013526:Surgical Mesh / Q000009:adverse effects*; D014550:Urinary Incontinence, Stress / Q000601:surgery*
keywords: mesh excision; mesh-related complication; sling; synthetic mesh