Investig Clin Urol.  2020 Feb;61(Suppl 1):S57-S63. 10.4111/icu.2020.61.S1.S57.

Tobacco use, immunosuppressive, chronic pain, and psychiatric conditions are prevalent in women with symptomatic mesh complications undergoing mesh removal surgery

• Blau EK
• Adelstein
• Amin KA
• Durfy SJ
• Lucioni A
• Kobashi KC
• Lee UJ

• KMID: 2469127
• DOI: http://doi.org/10.4111/icu.2020.61.S1.S57

Abstract

PURPOSE
To identify demographic and clinical characteristics of patients with symptomatic pelvic floor mesh complications who underwent mesh removal at our academic medical center. The secondary goal was to determine patient-reported outcomes after mesh removal.
MATERIALS AND METHODS
We conducted a retrospective review of consecutive patients from 2011-2016 undergoing removal of mesh graft for treatment of symptomatic mesh-related complications. Patient demographics, comorbidities, symptoms, and mesh factors were evaluated. Outcomes after explant were determined by the Patient Global Impression of Improvement and a Likert satisfaction scale.
RESULTS
One hundred fifty-six symptomatic patients underwent complete or partial pelvic floor mesh removal during the study period. Mid-urethral slings comprised 86% of explanted mesh grafts. Mesh exposure or erosion was identified in 72% of patients. Eighty-one percent of patients presented with pain, and 35% reported pain in the absence of exposure or erosion. Pre-operative comorbidities included psychiatric disease (54.5%), chronic pain (34.0%), irritable bowel syndrome (20.5%) and fibromyalgia (9.6%). Forty-three percent of patients reported current or past tobacco use. At mean follow-up of 14 months, 68% of responding patients reported improvement on the Patient Global Impression of Improvement after surgery.
CONCLUSIONS
This research identified tobacco use, and psychiatric, immunosuppressive, and chronic pain conditions as prevalent in this cohort of patients undergoing mesh removal. Surgical removal can improve presenting symptoms, including for patients with pain in the absence of other indications.

Keyword

Pain; Pelvic organ prolapse; Suburethral slings; Urinary incontinence; Urologic surgical procedures

MeSH Terms

Academic Medical Centers
Chronic Pain*
Cohort Studies
Comorbidity
Demography
Female
Fibromyalgia
Follow-Up Studies
Humans
Irritable Bowel Syndrome
Pelvic Floor
Pelvic Organ Prolapse
Retrospective Studies
Suburethral Slings
Tobacco Use*
Tobacco*
Transplants
Urinary Incontinence
Urologic Surgical Procedures

Figure

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  Fig. 1 International Urogynecological Association (IUGA)/International Continence Society (ICS) Grades of Pain Subclassification Scale, based on pre-operative assessment. A, asymptomatic or no pain; B, provoked pain only (during vaginal examination); C, pain during sexual intercourse; D, pain during physical activities; E, spontaneous pain.

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