Management of patients with mesh perforation into viscus following pelvic mesh surgery

TL;DR

This study examines the outcomes of surgically managing mesh perforation into organs after pelvic mesh surgery, finding that it effectively reduces infections and pain.

Contribution

The paper provides clinical evidence on the effectiveness of surgical management for mesh perforation into viscus, an uncommon but significant complication.

Findings

Surgical excision and viscus repair were successful in all 51 patients who underwent the procedure.

There was a significant reduction in recurrent urinary tract infections and pain after surgery.

No patients experienced complications like mesh erosion or fistulae after the procedure.

Abstract

Pelvic mesh has been used for the treatment of pelvic organ prolapse (POP) and stress urinary incontinence (SUI). Between 3 and 20% suffer complications with debilitating long-term outcomes. Uncommon complications include mesh perforation into viscus however there is minimal published data regarding outcomes following surgical management.

A retrospective observational study of patients with diagnosis of mesh in viscus at three tertiary urogynaecology units was performed to report on clinical outcomes following surgical management.

Fifty-eight patients were diagnosed with mesh in viscus following cystourethroscopy and thorough examination of vagina/rectum. Mesh involved included mid-urethral slings—retropubic (36.9%), transobturator (18.5%), single incision slings (10.8%); transvaginal POP mesh (15.4%); sacrocolpopexy (13.8%); uncertain type (4.6%). Viscus involved included bladder (39.7%), urethra (50%), bladder and urethra (3.4%), and rectum (6.9%). Main presenting symptoms included mixed urinary incontinence (UI) (75.9%), recurrent urinary tract infections (rUTIs) (48.3%) and rectal/pelvic pain (56.9%). Fifty-one patients underwent mesh excision and viscus repair, with successful repair in all (100%). 48% had complete mesh excision. Mean follow up was 9.5 months (range 0.5–96 months). Post-operatively, there was a statistically significant reduction in rUTIs (p = 0.0004) as well as pain (p = 0.000005). None had recurrent mesh erosion, lower genitourinary tract fistula or wound breakdown.

All patients required thorough examination and cystourethroscopy for diagnosis. Surgical management of mesh in viscus appears to have low morbidity and is shown to reduce symptoms of rUTIs and pain as well as risk of recurrent mesh erosion and fistulae.

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