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Assessment and initial management of mesh complications

Published:December 10, 2022DOI:https://doi.org/10.1016/j.ogrm.2022.11.001

      Abstract

      Synthetic polypropylene mesh have been used in the surgical management of pelvic organ prolapse (POP) and stress urinary incontinence (SUI) since 1990's. However, following patients'-led campaign with concerns regarding the complications associated with mesh, their use in surgical management of SUI and/or POP has been controversial. Complications associated with these mesh implants include chronic pain, vaginal mesh exposure, perforation into organs, infections and sinus tract formation. In April, 2019, the NICE guideline (NG123) provided an evidence review for management of mesh complications. Following Independent Medicine and Medical Devices Safety Review (IMMDS) publication in 2020, a network of specialized complex mesh centres across the UK have been set up. All patients with mesh-related complications should receive specialist multidisciplinary care in these centres. In this review, we outline the assessment and initial management of patients who present with mesh-related complications. Assessment and management options should be tailored per individual cases. Assessment includes clinical assessment and investigations including radiological imaging. All management options including no treatment, conservative, medical and surgical treatment, including minimally invasive treatment with the pros and cons of every option should be offered and patient should be actively involved in their decision making in a “shared-decision making” manner.

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      Further reading

        • Bueno Garcia Reyes P.
        • Hashim H.
        Mesh complications: best practice in diagnosis and treatment.
        Ther Adv Urol. 2020; 121756287220942993
        • Cumberlege J.
        First do no harm: the report of the independent medicines and medical devices safety review.
        2020
        • Mangir N.
        • Aldemir Dikici B.
        • Chapple C.R.
        • MacNeil S.
        Landmarks in vaginal mesh development: polypropylene mesh for treatment of SUI and POP.
        Nat Rev Urol. 2019; 16: 675-689
        • Misra S.
        • Tyagi V.
        Management of complications of mesh surgery.
        Obstet Gynaecol Reprod Med. 2019; 29: 314-319
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