Mesh erosion more common in women with dyslipidemia

Toronto-Patients with poor lipid control are more likely to face mesh erosion or shrinkage following pelvic organ prolapse surgery, a recent retrospective analysis has found.

"We found that patients with dyslipidemia tend to have more erosion and shrinkage [than those who do not]," said first author Javier Pizarro, MD, a gynecologist-obstetrician at the Hospital Dr. Sotero del Rio and the University Hospital of the Pontificia Universidad Catolica, Santiago, Chile. "It's a very novel finding."

In an interview following his poster presentation at the 2010 joint meeting of the International Continence Society and the International Urogynecological Association, Dr. Pizarro speculated that a heightened inflammatory state in patients with dyslipidemia may elicit a response to the mesh.

"We think the reduction [shrinkage] and erosion is a reaction against the mesh," he added.

Investigators aimed to identify epidemiologic factors that would influence erosion or shrinkage of the mesh in patients who underwent surgery using the anchored technique similar to that used with the PROLIFT prolapse repair system (Ethicon, Inc., Somerville, NJ). They looked at records from the hospital's 746 urogynecologic outpatients between January 2008 and January 2009 and found 309 surgeries were performed, with 88 being PROLIFT-like surgery.

A total of eight of 66 patients (12.1%) who experienced no erosion or shrinkage had dyslipidemia, while six of 22 (27.3%) of the patients who faced erosion or shrinkage had dyslipidemia. While the difference between the two groups did not hold statistical significance (p=.09), larger numbers would yield statistical significance, according to Dr. Pizarro.

He added that the study was not powered to show dyslipidemia is a risk factor for erosion or shrinkage of the mesh.

"We plan to conduct a prospective study to further examine this," Dr. Pizarro said.

"We will measure the patients' lipids preoperatively."

Menopausal status also a factor

Investigators also found that postmenopausal status influenced the risk of mesh erosion or risk shrinkage after PROLIFT-like surgery, a finding that opens another avenue of exploration for Dr. Pizarro and his colleagues.

A total of 62 of 66 patients (93.9%) who experienced no shrinkage or erosion of the mesh were postmenopausal, while 16 of 22 (72.7%) who experienced erosion or shrinkage were postmenopausal, a finding that was statistically significant (p=.0066).

"We need to do another study to ensure that we should just do the surgery in postmenopausal women," said Dr. Pizarro. "We can't issue a clinical guideline based on our findings from retrospective research."

There was no statistical difference in factors such as age, body mass index, smoking, or diabetes between patients who experienced erosion or shrinkage and those who did not.

There needs to be greater focus on the health status of the patient and how the patient is affected by mesh, Dr. Pizarro noted.