Search

Mesh is a synthetic material used to treat stress urinary incontinence (SUI) and pelvic organ prolapse (POP) in women. There have been several reports by patients of complications around the world and some countries have suspended the use of vaginally inserted mesh for the treatment of SUI and POP due to complications. The aim of this document is to address the types of mesh procedures performed and provide terminology for mesh removal which can be easily understood by health-care providers and patients/consumers, avoiding miscommunication which has been highlighted in the Cumberlege report in the United Kingdom.

Objective:: To review and summarize the peer-reviewed literature for Surgical Training and Research in Mesh Complications. Methods:: An international author team reviewed available published literature. Results:: This paper reviews the current training situation and recognizes there are no fellowships globally which specifically train in mesh removal/ complications. The UK has recently launched a mesh complications training pathway pilot. New Zealand has recently implemented a credentialing framework for pelvic floor procedures including mesh removal and undertaken national credentialing of surgeons. A proposed training pathway is outlined including training sequence, the training setting, and a modular pathway of training.The authors acknowledge that there is very limited research and evidence for management of mesh complications. Several important research questions are suggested for future research. Future projects for collaborative research are proposed including registries, and development of improved patient education materials for pelvic floor conditions to improve shared decision making.

Background:: Sacrohysteropexy and sacrocolpopexy are established treatments of uterine or vaginal vault prolapse respectively and involve insertion of mesh abdominally, often using permanent sutures and fixation devices. Complications following these procedures may be serious, and there is lack of evidence about long-term functional outcomes in terms of pain, dyspareunia and development of lower urinary tract and bowel symptoms. Objective:: A non-systematic review of the available literature was performed and recommendations on assessment and management were developed by expert consensus. Conclusion:: The current evidence is limited in quantity and quality, and recommendations on assessment management of mesh-related complications were made by experts in the field. Assessment and treatment of complications following abdominally placed mesh for pelvic organ prolapse will often require a multidisciplinary approach. Assessment may require EUA, and/or cystourethroscopy, sigmoidoscopy, and laparoscopy. MRI is the most useful imaging modality. Surgery to remove mesh carries a risk of urinary tract and bowel injury, as well as development of recurrent pelvic organ prolapse. A joint decision between the surgeon and the patient should be made before embarking on a partial removal of mesh; removal of all the mesh may be a better option albeit with higher risk of surgical complications. Complete removal of mesh and tacks or sutures from the sacral attachment may not be possible and is associated with risk of major haemorrhage.