Large review building insight on outcomes of surgical mesh removal

Findings from a study by UCLA urologists of all patients who underwent surgical mesh removal over a 6-year period will hopefully help surgeons who care for these patients with their management decisions and counseling efforts, researchers say.

The analyses included data from 236 women with a mean age of 59 years (range, 25 to 88) who underwent 319 mesh excision procedures between July 2005 and July 2011. Almost 60% of patients had mesh for pelvic organ prolapse and 86% had sling mesh.

The findings from analyses of history and outcomes highlighted that treatment for mesh complications is not for mesh exposure alone, as some combination of mesh exposure, pain, voiding dysfunction, infection, and recurrent prolapse was present in about one-third of the procedures. In addition, the data showed pain was common and had a significant negative impact on quality of life, but was improved after mesh removal in 80% of women overall and in all subgroups after stratification by mesh type.

However, nearly one-fourth of the women in the series needed multiple procedures to help achieve significant improvement of their presenting symptom(s).

"We were inspired to undertake this review because an increasing number of patients are presenting with mesh complications. However, the existing literature on management of these problems and the outcomes is limited and confusing. Therefore, we found it difficult to provide appropriate counseling," said first author Lisa Rogo-Gupta, MD, who conducted the study with Shlomo Raz, MD, and colleagues.

"We hope that our study will bring reliable information that can be used by us and others to give patients realistic expectations on how they can be helped. In addition, we want to encourage the physicians who treat patients with pelvic floor disorders to collaborate and use all available therapies in order to bring the affected women improved quality of life."

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