Top

International Urogynecology Journal

Published in:

01-09-2020 | Original Article

Lightweight transvaginal mesh is associated with lower mesh exposure rates than heavyweight mesh

Authors: Nicola Dykes, Debjyoti Karmakar, Lynsey Hayward

Published in: International Urogynecology Journal | Issue 9/2020

Abstract

Introduction and hypothesis

There has been a scarcity of long-term published data comparing lightweight versus heavier weight transvaginal mesh for prolapse repair. The aim was to ascertain the long-term rates of recurrent prolapse and mesh exposure in a cohort of vaginal repairs utilizing two different weights of transvaginal mesh.

Methods

Data were prospectively collected on all mesh-augmented vaginal prolapse repairs performed with Apogee® or Perigee® mesh kits (IntePro® or IntePro Lite®) at a single centre over an 11-year period, with patients receiving ongoing annual follow-up. A sequential stepwise univariate and multivariate Cox regression analysis was performed to identify variables that were significantly associated with mesh exposure.

Results

Eighty-eight women with 113 mesh kits were reviewed from the original cohort of 158 women. The median length of follow-up was 6.4 years (range 1.1–12.5 years). Mesh exposure rate per implant in the IntePro® group was 16/40 (40%) versus 4/73 (5.5%) in the IntePro Lite® group (p < 0.0001). A hazard ratio of 4.2 was identified for mesh exposure for IntePro® versus IntePro Lite® (95% CI 3.0–6.8). There was no difference in rates of recurrent prolapse between the heavy- and lightweight mesh groups.

Conclusions

Lightweight transvaginal mesh is associated with lower mesh exposure rates than heavyweight mesh at a median follow-up of 6.4 years, with no difference in rates of recurrent prolapse.

Nygaard I, Bradley C, Brandt D. Pelvic organ prolapse in older women: prevalence and risk factors. Obstet Gynecol. 2004;104(3):489–97. https://doi.org/10.1097/01.AOG.0000136100.10818.d8.CrossRefPubMed

Chow D, Rodriguez LV. Epidemiology and prevalence of pelvic organ prolapse. Curr Opin Urol. 2013;23(4):293–8. https://doi.org/10.1097/MOU.0b013e3283619ed0.CrossRefPubMed

Smith FJ, Holman CD, Moorin RE, Tsokos N. Lifetime risk of undergoing surgery for pelvic organ prolapse. Obstet Gynecol. 2010;116(5):1096–100. https://doi.org/10.1097/AOG.0b013e3181f73729.CrossRefPubMed

Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol. 1997;89(4):501–6. https://doi.org/10.1016/s0029-7844(97)00058-6.CrossRefPubMed

Jonsson Funk M, Edenfield AL, Pate V, Visco AG, Weidner AC, Wu JM. Trends in use of surgical mesh for pelvic organ prolapse. Am J Obstet Gynecol. 2013;208(1):79.e71–7. https://doi.org/10.1016/j.ajog.2012.11.008.CrossRef

FDA News Release 16 April 2019 https://www.fda.gov/news-events/press-announcements/fda-takes-action-protect-womens-health-orders-manufacturers-surgical-mesh-intended-transvaginal.

Karmakar D, Hayward L, Smalldridge J, Lin S. Vaginal mesh for prolapse: a long-term prospective study of 218 mesh kits from a single centre. Int Urogynecol J. 2015;26(8):1161–70. https://doi.org/10.1007/s00192-015-2658-0.CrossRefPubMed

Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J. 2010;21(1):5–26. https://doi.org/10.1007/s00192-009-0976-9.CrossRefPubMed

Karmakar D HL, Lin S, Smalldridge J (2014) A calculator for risk prediction of mesh extrusion in vaginal mesh augmented repair: a novel translational approach to risk counselling and decision making in urogynaecology. Int Urogynecol J 25. https://doi.org/10.1007/s00192-014-2429-3.

10.

Curtiss N, Duckett J. A long-term cohort study of surgery for recurrent prolapse comparing mesh augmented anterior repairs to anterior colporrhaphy. Gynecol Surg. 2018;15(1):1. https://doi.org/10.1186/s10397-017-1035-z.CrossRefPubMedPubMedCentral

11.

Maher C, Feiner B, Baessler K, Christmann-Schmid C, Haya N, Marjoribanks J. Transvaginal mesh or grafts compared with native tissue repair for vaginal prolapse. Cochrane Database Syst Rev. 2016;2:Cd012079. https://doi.org/10.1002/14651858.Cd012079.CrossRefPubMed

12.

Rane A, Iyer J, Kannan K, Corstiaans A. Prospective study of the perigee system for treatment of cystocele—our five-year experience. Aust N Z J Obstet Gynaecol. 2012;52(1):28–33. https://doi.org/10.1111/j.1479-828X.2011.01384.x.CrossRefPubMed

13.

Glazener CMA, Breeman S, Elders A, Hemming C, Cooper KG, Freeman RM. Mesh, graft, or standard repair for women having primary transvaginal anterior or posterior compartment prolapse surgery: two parallel-group, multicentre, randomised, controlled trials (PROSPECT). Lancet. 2017;389(10067):381–92. https://doi.org/10.1016/s0140-6736(16)31596-3.CrossRefPubMed

14.

Donati M, Brancato G, Grosso G, Li Volti G, La Camera G, Cardi F. Immunological reaction and oxidative stress after light or heavy polypropylene mesh implantation in inguinal hernioplasty: a CONSORT-prospective, randomized, clinical trial. Medicine. 2016;95(24):e3791. https://doi.org/10.1097/md.0000000000003791.CrossRefPubMedPubMedCentral

15.

Liang R, Abramowitch S, Knight K, Palcsey S, Nolfi A, Feola A. Vaginal degeneration following implantation of synthetic mesh with increased stiffness. BJOG. 2013;120(2):233–43. https://doi.org/10.1111/1471-0528.12085.CrossRefPubMedPubMedCentral

16.

Feola A, Abramowitch S, Jallah Z, Stein S, Barone W, Palcsey S. Deterioration in biomechanical properties of the vagina following implantation of a high-stiffness prolapse mesh. BJOG. 2013;120(2):224–32. https://doi.org/10.1111/1471-0528.12077.CrossRefPubMedPubMedCentral

17.

Liang R, Knight K, Abramowitch S, Moalli PA. Exploring the basic science of prolapse meshes. Curr Opin Obstet Gynecol. 2016;28(5):413–9. https://doi.org/10.1097/gco.0000000000000313.CrossRefPubMedPubMedCentral

18.

Kelly EC, Winick-Ng J, Welk B. Surgeon experience and complications of transvaginal prolapse mesh. Obstet Gynecol. 2016;128(1):65–72. https://doi.org/10.1097/aog.0000000000001450.CrossRefPubMed

19.

Management of Mesh and Graft Complications in Gynecologic Surgery. Female pelvic medicine & reconstructive surgery 2017;23(3):171–176. https://doi.org/10.1097/spv.0000000000000425

20.

Lo TS, Tan YL, Cortes EF, Wu PY, Pue LB, Al-Kharabsheh A. Clinical outcomes of mesh exposure/extrusion: presentation, timing and management. Aust N Z J Obstet Gynaecol. 2015;55(3):284–90. https://doi.org/10.1111/ajo.12340.CrossRefPubMed

21.

Tijdink MM, Vierhout ME, Heesakkers JP, Withagen MI. Surgical management of mesh-related complications after prior pelvic floor reconstructive surgery with mesh. Int Urogynecol J. 2011;22(11):1395–404. https://doi.org/10.1007/s00192-011-1476-2.CrossRefPubMedPubMedCentral

22.

Cundiff GW, Quinlan DJ, van Rensburg JA, Slack M. Foundation for an evidence-informed algorithm for treating pelvic floor mesh complications: a review. Bjog. 2018;125(8):1026–37. https://doi.org/10.1111/1471-0528.15148.CrossRefPubMed

Title: Lightweight transvaginal mesh is associated with lower mesh exposure rates than heavyweight mesh
Authors: Nicola Dykes
Debjyoti Karmakar
Lynsey Hayward
Publication date: 01-09-2020
Publisher: Springer International Publishing
Published in: International Urogynecology Journal / Issue 9/2020
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-020-04270-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Lightweight transvaginal mesh is associated with lower mesh exposure rates than heavyweight mesh

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 9/2020

Subjective versus objective determination of bladder emptying following urogynecological surgery: “do you feel that you completely emptied your bladder?”

A commentary on “Age-associated differences in macrophage response in a vaginal wound healing rat model”

Pelvic floor disorder symptoms and bone strength in postmenopausal women

Laparoscopic management of pelvic organ prolapse recurrence after open sacrocervicopexy

Pelvic organ prolapse in Northwest Ethiopia: a population-based study

Bowel lesion with TVT; early diagnostics and proper treatment of a severe complication