Histopathology of excised midurethral sling mesh.
OBJECTIVE
The objective of this study was to compare the histological characteristics of pathological specimens of excised midurethral sling mesh and surrounding vaginal tissue in patients who presented preoperatively with pain and/or exposure of mesh to patients who underwent mesh excision for voiding dysfunction without pain and/or erosion.


METHODS
This is a retrospective case-control study of women who underwent excision of midurethral sling mesh between 2008 and 2013. Three groups were identified: (1) voiding dysfunction without pain or exposure (control group), (2) pain and/or mesh exposure, and (3) voiding dysfunction with pain and/or mesh exposure. All original pathological specimens were rereviewed by one pathologist blinded to indication for excision and the previous pathology report. Degree of inflammation and fibrosis were recorded based on a 4-point scale along with the presence of giant cell reaction.


RESULTS
A total of 130 subjects met inclusion criteria: 60 (46.2 %) with voiding dysfunction only, 21 (16.2 %) with pain/erosion, and 49 (37.7 %) with both pain/exposure and voiding dysfunction. The voiding dysfunction only group was found to have significantly higher levels of inflammation, median grade 2 (1-3), compared to the other two groups with a p value of 0.007. There were no statistical differences in fibrosis and giant cell reaction between the three groups.


CONCLUSIONS
Midurethral sling mesh excised for voiding dysfunction demonstrates elevated levels of inflammation compared to mesh that is excised for pain and/or exposure. The vaginal tissue fibrosis and giant cell reaction are similar in patients who undergo mesh excision for voiding dysfunction and pain, and/or mesh exposure.
Obstetrics/Gynecology and Women's Health Institute, Center for Urogynecology and Pelvic Reconstructive Surgery, Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk A81, Cleveland, OH, USA, hilla8@ccf.org.
Audra Jolyn
AJ
Hill
Cecile A
CA
Unger
Ellen R
ER
Solomon
Jennifer A
JA
Brainard
Matthew D
MD
Barber
D000328:Adult; D016022:Case-Control Studies; D020878:Device Removal; D005260:Female; D005355:Fibrosis / Q000473:pathology; D015743:Giant Cells, Foreign-Body / Q000473:pathology; D006801:Humans; D007249:Inflammation / Q000473:pathology; D008875:Middle Aged; D010146:Pain / Q000209:etiology / Q000473:pathology*; D012189:Retrospective Studies; D053825:Suburethral Slings / Q000009:adverse effects*; D013526:Surgical Mesh / Q000009:adverse effects*; D014555:Urination Disorders / Q000209:etiology / Q000473:pathology*; D014621:Vagina / Q000473:pathology*