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International Urogynecology Journal

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01-10-2016 | Original Article

Seeking new surgical predictors of mesh exposure after transvaginal mesh repair

Authors: Pei-Ying Wu, Chih-Hung Chang, Meng-Ru Shen, Cheng-Yang Chou, Yi-Ching Yang, Yu-Fang Huang

Published in: International Urogynecology Journal | Issue 10/2016

Abstract

Introduction and hypothesis

The purpose of this study was to explore new preventable risk factors for mesh exposure.

Methods

A retrospective review of 92 consecutive patients treated with transvaginal mesh (TVM) in the urogynecological unit of our university hospital. An analysis of perioperative predictors was conducted in patients after vaginal repairs using a type 1 mesh. Mesh complications were recorded according to International Urogynecological Association (IUGA) definitions. Mesh-exposure-free durations were calculated by using the Kaplan−Meier method and compared between different closure techniques using log-rank test. Hazard ratios (HR) of predictors for mesh exposure were estimated by univariate and multivariate analyses using Cox proportional hazards regression models.

Results

The median surveillance interval was 24.1 months. Two late occurrences were found beyond 1 year post operation. No statistically significant correlation was observed between mesh exposure and concomitant hysterectomy. Exposure risks were significantly higher in patients with interrupted whole-layer closure in univariate analysis. In the multivariate analysis, hematoma [HR 5.42, 95 % confidence interval (CI) 1.26–23.35, P = 0.024), Prolift mesh (HR 5.52, 95 % CI 1.15–26.53, P = 0.033), and interrupted whole-layer closure (HR 7.02, 95 % CI 1.62–30.53, P = 0.009) were the strongest predictors of mesh exposure.

Conclusion

Findings indicate the risks of mesh exposure and reoperation may be prevented by avoiding hematoma, large amount of mesh, or interrupted whole-layer closure in TVM surgeries. If these risk factors are prevented, hysterectomy may not be a relative contraindication for TVM use. We also provide evidence regarding mesh exposure and the necessity for more than 1 year of follow-up and preoperative counselling.

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Title: Seeking new surgical predictors of mesh exposure after transvaginal mesh repair
Authors: Pei-Ying Wu
Chih-Hung Chang
Meng-Ru Shen
Cheng-Yang Chou
Yi-Ching Yang
Yu-Fang Huang
Publication date: 01-10-2016
Publisher: Springer London
Published in: International Urogynecology Journal / Issue 10/2016
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-016-2996-6

At a glance: The STEP trials

Springer Medicine

Seeking new surgical predictors of mesh exposure after transvaginal mesh repair

Abstract

Introduction and hypothesis

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction and hypothesis

Methods

Results

Conclusion

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