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. 2021 Nov;128(12):2034-2043.
doi: 10.1111/1471-0528.16778. Epub 2021 Jun 27.

Symptomatic improvement after mesh removal: a prospective longitudinal study of women with urogynaecological mesh complications

N Pace  1 , A Artsen  2   3 , L Baranski  2 , S Palcsey  3 , R Durst  2 , L Meyn  1 , P A Moalli  2   3
Affiliations

Symptomatic improvement after mesh removal: a prospective longitudinal study of women with urogynaecological mesh complications

N Pace et al. BJOG. 2021 Nov.

Abstract

Objective: To compare clinical characteristics and outcomes in patients undergoing excision of polypropylene urogynaecological mesh for pain, mesh exposure or both.

Design: Prospective, longitudinal cohort.

Setting: Academic tertiary referral centre.

Population: Women undergoing complete vaginal mesh excision for mesh exposure and/or pain.

Methods: Clinical and patient-reported outcomes assessing pain (visual analog scale, VAS), bother (Pelvic Floor Distress Inventory, PFDI) and functional impact (Pelvic Functional Impact Questionnaire, PFIQ) were collected at baseline, 6, 12 and 24 months after complete mesh excision. Outcomes were compared by mesh type (sling, prolapse [transvaginal or sacrocolpopexy mesh], both) and complication (pain, exposure, both).

Main outcome measures: 'Much better' or 'Very much better' on Patient Global Impression of Improvement (PGI-I) up to 2 years after removal.

Results: Of 173 women, 48 underwent removal for pain, 27 for exposure and 98 for exposure plus pain. 'Moderate to severe' baseline symptoms were reported by 75%; the most prevalent and severe symptom was dyspareunia. Patients with pain alone were most bothered (PFDI median 234.2, interquartile range 83, P = 0.02) and had the highest functional impact (PFIQ median 181, interquartile range 138, P < 0.001). After excision, only 33.3% of women with pain alone reported 'improved' symptoms (PGI-I), versus 73.9% with exposure, 58.3% with exposure plus pain (P = 0.03) with no differences in PGI-I by mesh type. VAS scores decreased in all groups, but PFDI and PFIQ did not improve in pain patients.

Conclusions: In women experiencing a pain complication after urogynaecological mesh insertion, mesh removal often does not improve symptoms.

Tweetable abstract: Only 33% of women with pain complications have improved symptoms after urogynaecological mesh removal.

Keywords: Complications; mesh removal; patient-reported outcomes; urogynaecological mesh.

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Figures

Figure 1.
Figure 1.. Comparison of dyspareunia, pelvic pain and dysuria visual analog scale (VAS) scores before and after mesh removal.
(A-C) VAS scores before and after mesh removal stratified by primary complication symptom (pain, exposure, exposure + pain) A. Dyspareunia; B. Pelvic Pain; C. Dysuria. (D-F) VAS scores before and after mesh removal stratified by the type of mesh removed. D. Dyspareunia; E. Pelvic Pain; F. Dysuria. Comparisons were made between groups pre- and post-operatively with Kruskal-Wallis. The ends of the boxes represent the 25th and 75th percentiles, the horizontal line indicate the median and the whiskers represent upper and lower adjacent values. Outlier data are shown as circles plotted beyond the whiskers. The proportion of groups meeting MCID score cutoffs post-operatively were compared with Fisher’s Exact and significant differences are noted with asterisks (*). VAS: visual analog scale
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