%0 Journal Article
%T Mesh Exposure and Associated Risk Factors in Women Undergoing Transvaginal Prolapse Repair with Mesh
%A Elizabeth A. Frankman
%A Marianna Alperin
%A Gary Sutkin
%A Leslie Meyn
%A Halina M. Zyczynski
%J Obstetrics and Gynecology International
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/926313
%X Objective. To determine frequency, rate, and risk factors associated with mesh exposure in women undergoing transvaginal prolapse repair with polypropylene mesh. Methods. Retrospective chart review was performed for all women who underwent Prolift Pelvic Floor Repair System (Gynecare, Somerville, NJ) between September 2005 and September 2008. Multivariable logistic regression was performed to identify risk factors for mesh exposure. Results. 201 women underwent Prolift. Mesh exposure occurred in 12% (24/201). Median time to mesh exposure was 62 days (range: 10¨C372). When mesh was placed in the anterior compartment, the frequency of mesh exposure was higher than that when mesh was placed in the posterior compartment (8.7% versus 2.9%, ). Independent risk factors for mesh exposure were diabetes (AOR£¿=£¿7.7, 95% CI 1.6¨C37.6; ) and surgeon (AOR£¿=£¿7.3, 95% CI 1.9¨C28.6; ). Conclusion. Women with diabetes have a 7-fold increased risk for mesh exposure after transvaginal prolapse repair using Prolift. The variable rate of mesh exposure amongst surgeons may be related to technique. The anterior vaginal wall may be at higher risk of mesh exposure as compared to the posterior vaginal wall. 1. Introduction Mesh augmentation has been widely adopted for pelvic floor reconstructive procedures [1]. Sacral colpopexy is considered to be the ¡°gold standard¡± surgical procedure based on favorable subjective and objective outcomes and a relatively low complication rate [2¨C4]. It has demonstrated superior durability when compared to transvaginal plication techniques using native tissues [2, 5]. In 2004, the Food and Drug Administration (FDA) approved the first commercial ¡°system¡± or ¡°kit¡± for the transvaginal delivery of polypropylene mesh into the vesicovaginal and/or rectovaginal plane for the treatment of uterine or vaginal vault prolapse. The goal of transvaginal mesh augmentation was to provide the durability of sacral colpopexy while avoiding the morbidity associated with laparotomy or prolonged laparoscopy. Following FDA approval, transvaginal mesh kits were widely adopted with an estimated 75,000 transvaginal mesh procedures for prolapse performed in 2010 [6]. In 2008 and 2011, the FDA issued statements due to concern regarding the frequency of complications associated with the use of transvaginal mesh for prolapse repair [6, 7]. Mesh exposure appears to be the most common complication and is documented by the visualization of graft material within the vagina. Although this public advisory resulted in the removal of several mesh kits from the market, investigation of
%U http://www.hindawi.com/journals/ogi/2013/926313/