title: Clinical outcomes of mesh exposure/extrusion: presentation, timing and management.
abstract: BACKGROUND
  The Food and Drug Administration has recently highlighted an increase in reported complications associated with the use of transvaginal mesh.
  
  
  OBJECTIVE
  To describe the clinical outcomes, presentation, timing and management of mesh exposure/extrusion
  
  
  METHODS
  Retrospective study from December 2006 to March 2012. A total of 40 women had vaginal mesh exposure/extrusion secondary to prior transvaginal mesh (TVM) surgery. Descriptive statistics were used for demographics and pre-operative data. Paired-samples t-test was applied for comparison of pre- and postoperation. A P value of <0.05 was considered statistically significant.
  
  
  RESULTS
  The mesh exposure/extrusion rate was noted to be 2.64% (17/642). Vaginal bleeding in 29 of 40 (72.5%) and hispareunia in 12 of 13 (92.3%) were identified as the most common symptoms for mesh exposure/extrusion. The onset of complications occurred in two peaks: between 3 and 4 months and after 1-year of follow-up. Initial conservative treatment was given for 12.5% (5/40) of women, while 87.5% (35/40) had undergone repair for mesh exposure/extrusion (21 outpatient and 14 inpatient cases). Among those who had conservative treatment, 80% (4/5) had persistent mesh exposure.
  
  
  CONCLUSIONS
  Persistent or new-onset abnormal vaginal bleeding and hispareunia after TVM surgery should be considered as 'red flag' symptoms for mesh exposure/extrusion. Frequent follow-up from the first 3-4 months up to 1 year postoperative may identify complications. Utilisation of mesh excision or trimming as the initial means of treatment may yield a better outcome.
authors.affiliation: Department of Obstetrics and Gynecology, Keelung and Taipei, Medical Center, Chang Gung Memorial Hospital, Keelung, Taiwan.|Division of Urogynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Linkou, Linkou, Taiwan.|School of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Tsia-Shu
authors.initials: TS
authors.lastname: Lo
authors.affiliation: Fellow of the Division of Urogynecology, Department of Obstetrics and Gynecology, School of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.|Kuching Specialist Hospital, KPJ and Department of Obstetrics and Gynecology, Sarawak General Hospital, Kuching, Sarawak, Malaysia.
authors.forename: Yiap Loong
authors.initials: YL
authors.lastname: Tan
authors.affiliation: Fellow of the Division of Urogynecology, Department of Obstetrics and Gynecology, School of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.|Department of Obstetrics and Gynecology, De La Salle University Medical Center, Dasmariñas, Cavite, Philippines.
authors.forename: Eileen Feliz M
authors.initials: EF
authors.lastname: Cortes
authors.affiliation: Department of Obstetrics and Gynecology, Keelung and Taipei, Medical Center, Chang Gung Memorial Hospital, Keelung, Taiwan.
authors.forename: Pei-Ying
authors.initials: PY
authors.lastname: Wu
authors.affiliation: Fellow of the Division of Urogynecology, Department of Obstetrics and Gynecology, School of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.|Department of Obstetrics and Gynecology, Hospital Serdang, Kajang, Selangor, Malaysia.
authors.forename: Leng Boi
authors.initials: LB
authors.lastname: Pue
authors.affiliation: Fellow of the Division of Urogynecology, Department of Obstetrics and Gynecology, School of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.|Department of Obstetrics and Gynecology, King Abdullah University Hospital, University of Science and Technology, Irbid, Jordan.
authors.forename: Ahlam
authors.initials: A
authors.lastname: Al-Kharabsheh
mesh_terms: D000368:Aged; D004414:Dyspareunia / Q000209:etiology* / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D056887:Pelvic Organ Prolapse / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D013526:Surgical Mesh / Q000009:adverse effects*; D011795:Surveys and Questionnaires; D013997:Time Factors; D014592:Uterine Hemorrhage / Q000209:etiology* / Q000628:therapy
keywords: hispareunia; mesh exposure/extrusion; transvaginal mesh; vaginal bleeding