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Pathology Of Explanted Transvaginal Meshes

Authors: Iakovlev, Vladimir V.; Carey, Erin T.; Steege, John;

Pathology Of Explanted Transvaginal Meshes

Abstract

{"references": ["Sivaslioglu A. A., Unlubilgin E., & Dolen I., \"A randomized\ncomparison of polypropylene mesh surgery with site-specific surgery in\nthe treatment of cystocoele,\" Int Urogynecol J Pelvic Floor Dysfunct,\nvol. 19, no. 4, pp. 467-471, Apr. 2008.", "Nguyen J. N., & Burchette R. J., \"Outcome after anterior vaginal\nprolapse repair: a randomized controlled trial,\" Obstet Gynecol, vol. 111,\nno. 4, pp. 891-898, Apr. 2008.", "Carey M., Higgs P., Goh J., Lim J., Leong A., Krause H., & Cornish A.,\n\"Vaginal repair with mesh versus colporrhaphy for prolapse: a\nrandomised controlled trial,\" BJOG, vol. 116, no. 10, pp. 1380-1386,\nSpt. 2009.", "Iglesia C. B., Sokol A. I., Sokol E. R., Kudish B. I., Gutman R. E.,\nPeterson J. L., & Shott S., \"Vaginal mesh for prolapse: a randomized\ncontrolled trial,\" Obstet Gynecol, vol. 116 (2 Pt 1), pp. 293-303, Aug.\n2010.", "Nieminen K., Hiltunen R., Takala T., Heiskanen E., Merikari M., Niemi\nK., & Heinonen P. K., \"Outcomes after anterior vaginal wall repair with\nmesh: a randomized, controlled trial with a 3 year follow-up,\" Am J\nObstet Gynecol, vol. 203, no. 3, 235 e231-238, Spt. 2010.", "Withagen M. I., Milani A. L., den Boon J., Vervest H. A., & Vierhout\nM. E., \"Trocar-guided mesh compared with conventional vaginal repair\nin recurrent prolapse: a randomized controlled trial,\" Obstet Gynecol,\nvol. 117(2 Pt 1), pp. 242-250, Feb. 2011.", "Altman D., Vayrynen T., Engh M. E., Axelsen S., & Falconer C.,\n\"Anterior colporrhaphy versus transvaginal mesh for pelvic-organ\nprolapse,\" N Engl J Med, vol. 364, no. 19, pp. 1826-1836, May 2011.", "Vollebregt A., Fischer K., Gietelink D., & van der Vaart C. H., \"Primary\nsurgical repair of anterior vaginal prolapse: a randomised trial\ncomparing anatomical and functional outcome between anterior\ncolporrhaphy and trocar-guided transobturator anterior mesh,\" BJOG,\nvol. 118, no.12, pp. 1518-1527, Nov. 2011.", "Abed H., Rahn D. D., Lowenstein L., Balk E. M., Clemons J. L., &\nRogers R. G., \"Incidence and management of graft erosion, wound\ngranulation, and dyspareunia following vaginal prolapse repair with\ngraft materials: a systematic review,\" Int Urogynecol J, vol. 22, no. 7,\npp. 789-798, Jul. 2011.\n[10] Foon R., Toozs-Hobson P., & Latthe P. M., \"Adjuvant materials in\nanterior vaginal wall prolapse surgery: a systematic review of\neffectiveness and complications,\" Int Urogynecol J Pelvic Floor\nDysfunct,, vol. 19, no.12, pp. 1697-1706, Dec. 2008.\n[11] Smith T.M., Smith S.C., Delancey J.O., Fenner D.E., Schimpf M.O.,\nRoh M.H., Morgan D.M., \"Pathologic evaluation of explanted vaginal\nmesh: interdisciplinary experience from a referral center,\" Female Pelvic\nMed Reconstr Surg., vol. 19,no. 4, pp. 238-41, Jul. 2013.\n[12] Bendavid R., Lou W., Koch A., Iakovlev V., \"Mesh-Related SIN\nSyndrome. A Surreptitious Irreversible Neuralgia and Its Morphologic\nBackground in the Etiology of Post-Herniorrhaphy Pain,\" Int J Clin\nMed, vol. 5, pp. 799-810, 2014."]}

The use of polypropylene mesh devices for Pelvic Organ Prolapse (POP) spread rapidly during the last decade, yet our knowledge of the mesh-tissue interaction is far from complete. We aimed to perform a thorough pathological examination of explanted POP meshes and describe findings that may explain mechanisms of complications resulting in product excision. We report a spectrum of important findings, including nerve ingrowth, mesh deformation, involvement of detrusor muscle with neural ganglia, and polypropylene degradation. Analysis of these findings may improve and guide future treatment strategies.

Keywords

mesh, nerves, Transvaginal, polypropylene degradation.

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