Abstract: PD17-09
Sources of Funding: None

Introduction

Complications related to mesh implants for pelvic organ prolapse or incontinence are an important and controversial issue. However, there is limited literature on preoperative factors and outcomes of patients undergoing mesh removal. We present our experience with pelvic floor mesh explant surgery at a tertiary referral center. We aim to evaluate patient characteristics in an effort to identify factors that could predispose patients to mesh complications and assess patient reported outcomes to determine if preexisting symptoms successfully abate following mesh removal.

Methods

This is a retrospective case series of consecutive patients undergoing removal of mesh graft for treatment of symptomatic mesh related complications from 2011-16. Cases were identified by CPT codes 57287, 57295 and 57296. Patient demographics, comorbidities, symptoms and mesh factors were evaluated. Patient reported outcomes were determined by validated self-assessment instruments: patient global impression of improvement (PGI-I) and Likert satisfaction scale (0-10).

Results

147 symptomatic patients underwent complete or partial pelvic floor mesh removal by 3 subspecialized urologists. Results and presenting symptoms are summarized in Table 1. Associated comorbidities include prior or current tobacco use, psychiatric disease, chronic pain, irritable bowel syndrome and fibromyalgia. 80% of patients reported pain. Mesh exposure or erosion was identified in 83% of patients. Mid urethral sling comprised 86% of explanted mesh grafts. At mean follow up of 14 months, 68% reported improvement after surgery (PGI-I mean 2.9, SD ± 1.68) and were satisfied (Likert score mean 7.4, SD ± 3).

Conclusions

Excision of symptomatic mesh implants can successfully improve presenting symptoms and bother based on intermediate follow-up. Most patients undergoing mesh removal presented with pain in the presence of mesh erosion or exposure, but 28% reported pain in the absence of mesh exposure or erosion. This cohort also demonstrates coexisting psychiatric, immunosuppressive, and other chronic pain conditions that should be further investigated for impact on the development of mesh complications. Patients who do develop symptomatic pelvic floor mesh complications should be counseled on the option of surgical removal.

Funding

None