Symptom Improvement After Prolapse and Incontinence Graft Removal in a Case Series of 306 Patients.
OBJECTIVE
We report our experience with removal of synthetic and biologic implants used in pelvic reconstruction in a tertiary referral center from 2005 to 2012.


METHODS
We performed a retrospective cohort study of all consecutive patients who underwent surgical implant removal for treatment of implant-related complications. Symptoms were determined by patient self-assessment including validated questionnaires. One hundred seventy-nine patients completed follow-up.


RESULTS
Three hundred six patients underwent removal for exposure or erosion (57%), pain (46%), and urinary symptoms or incontinence (54%). Ninety patients (29%) had previous revision. Eleven percent had pelvic organ prolapse (POP) implants, 48% had sling implants, and 41% had both implants. Mean time from removal to follow-up was 2 years (median, 2 years; range, <1-7).The majority of patients experienced symptom improvement after implant removal. Seventy-eight percent of those with pain reported pain improvement, 9% reported no change, and 14% experienced worsening. Symptom improvement was reported by 79% of those who underwent removal of a POP implant alone, 79% of those who underwent removal of POP and sling implants, and 83% of those who underwent removal of a sling alone. Quality of life was significantly improved after implant removal overall (P < 0.05) for those who underwent removal of POP and slings, and slings alone, but not for those with POP removal only.


CONCLUSIONS
Pain is among the most common symptoms reported in women referred to our institution for implant-related complications. In a series of 306 complex patients with a range of implants and symptoms, removal improved implant-related pain in the majority of patients.
From the *Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, Stanford University Medical Center, Stanford; †Division of Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of California Los Angeles; ‡David Geffen School of Medicine, University of California Los Angeles; §Division of Pelvic Medicine and Reconstructive Surgery, Institute of Urology, University of Southern California; and ∥Division of Pelvic Medicine and Reconstructive Surgery, Department of Urology, University California Los Angeles, Los Angeles, CA.
Lisa
L
Rogo-Gupta
Tamara
T
Grisales
Linda
L
Huynh
Larissa V
LV
Rodríguez
Shlomo
S
Raz
D000368:Aged; D020878:Device Removal; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D010146:Pain / Q000601:surgery*; D056887:Pelvic Organ Prolapse / Q000601:surgery*; D011183:Postoperative Complications / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D012647:Self-Assessment; D053825:Suburethral Slings / Q000009:adverse effects*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000601:surgery*