Systematic review and classification of complications after anterior, posterior, apical, and total vaginal mesh implantation for prolapse repair.
In this review we focus on the transvaginal meshes used for pelvic organ prolapse (POP) repair and possible changes in application after the first FDA warning in 2008. A systematic review of the literature was performed. The data was reviewed for reoperation rates and complications following the Clavien-Dindo classification. A total of 11 randomized controlled and 9 prospective studies with 2,289 patients (most POP-Q ≥ II, median follow-up 12 mos) were included. The results showed a mean total complication rate of 27% in anterior, 20% in posterior, and 40% in combined mesh repair group (ns). Grade ≥ III complications occurred in 8% anterior, 3.5% posterior, and 13% combined (p < 0.05) mesh repairs. No differences were found for reoperation rates for POP (2% to 3%). The following risk factors for complications were identified: operative technique, surgeon experience, previous prolapse repair, concomitant hysterectomy, total mesh repair, mesh properties (light weight, collagen coating were positive factors), young age, sexual activity, and smoking. Due to high complication rates (especially mesh erosion, voiding dysfunction, and dyspareunia) a careful individualized selection of patients and materials, education of patients, and elimination of identified risk factors are urgent prior to implantation of vaginal meshes.
Department of Urology Lukas Hospital Neuss, Germany.
Dimitri
D
Barski
Department of Urology Lukas Hospital Neuss, Germany Director German Centre for Assessment and Evaluation of Innovative Techniques in Medicine Neuss, Germany.
Thomas
T
Otto
Department of Urology Lukas Hospital Neuss, Germany Research Associate German Centre for Assessment and Evaluation of Innovative Techniques in Medicine Neuss, Germany.
Holger
H
Gerullis
D005260:Female; D006801:Humans; D056887:Pelvic Organ Prolapse / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology*; D012086:Reoperation / Q000706:statistics & numerical data*; D013526:Surgical Mesh / Q000009:adverse effects*; D014621:Vagina / Q000601:surgery*