Long-term follow-up of treatment for synthetic mesh complications.
OBJECTIVE
The objectives of this study are (1) to describe the presenting symptoms, findings, and treatment and (2) to describe the self-reported improvement and function at least 6 months after presentation in women presenting to 1 urogynecology division for complications associated with synthetic vaginal mesh.


METHODS
Women evaluated between 2006 and 2011 were identified by diagnostic codes. We abstracted information from the medical record and attempted to contact all women to complete a follow-up telephone survey questionnaire consisting of several validated instruments.


RESULTS
A total of 111 women were evaluated for complications associated with synthetic vaginal mesh. The mean interval from index surgery was 2.4 years. Of these, 84% were referred from outside hospitals. Index surgeries included vaginal mesh kits/vaginally placed mesh (47%), midurethral mesh slings (37%), abdominally placed vaginal mesh (11%), and vaginal mesh kit with concomitantly placed mesh sling (5%). The most common complications were extrusion (65%), contraction (17%), and chronic pelvic pain (16%). A total of 98 women underwent some type of treatment (85 surgical) by urogynecologists, pelvic pain specialists, or physical therapists. Eighty-four (76%) provided follow-up information at mean interval since presentation of 2.3 years. At follow-up, the mean (SD) Pelvic Floor Distress Inventory score was 98 (67), the mean (SD) EQ-5D index score was 0.69 (0.23), and 22% reported vaginal discharge, 15% vaginal bleeding or spotting, and 45% sexual abstinence due to problems related to mesh. A total of 71% reported being overall better, whereas 29% were the same or worse.


CONCLUSIONS
Two years after tertiary care level multidisciplinary treatment of vaginal mesh complications, many women still report symptoms that negatively impact their quality of life.
From the Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT.
Brooke L
BL
Hansen
Guinn Ellen
GE
Dunn
Peggy
P
Norton
Yvonne
Y
Hsu
Ingrid
I
Nygaard
D059350:Chronic Pain / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D005547:Foreign Bodies / Q000209:etiology / Q000628:therapy; D006801:Humans; D008875:Middle Aged; D061646:Operative Time; D017060:Patient Satisfaction; D056887:Pelvic Organ Prolapse / Q000523:psychology / Q000601:surgery; D017699:Pelvic Pain / Q000209:etiology / Q000628:therapy; D011788:Quality of Life; D012086:Reoperation; D012189:Retrospective Studies; D012735:Sexual Dysfunction, Physiological / Q000209:etiology / Q000628:therapy; D053825:Suburethral Slings / Q000009:adverse effects; D013526:Surgical Mesh / Q000009:adverse effects*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000523:psychology / Q000601:surgery; D016055:Urinary Retention / Q000209:etiology / Q000628:therapy; D014592:Uterine Hemorrhage / Q000209:etiology / Q000628:therapy; D019522:Vaginal Discharge / Q000209:etiology / Q000628:therapy