Mesh Erosion After Anterior Prosthetic Reinforcement by Vaginal Route: Risk Factors and Management

Abstract

This study aimed to evaluate the occurrence, the risk factors, and the management of patients undergoing mesh erosion following an anterior prosthetic reinforcement by the vaginal route. We retrospectively reviewed the medical records of 247 consecutive patients who underwent a vaginal prosthetic reinforcement for cystocele and/or a suburethral sling urethropexy for stress urinary incontinence (SUI). With a minimal follow-up of 24 months, 18 cases of vaginal erosions occurred (7.3%). Four groups of risk factors were identified: (1) a prior history of vaginal surgery; (2) the absence of symptomatic SUI, uterine prolapse, and rectocele grade III; (3) the type of colpotomy, colpectomy, rectovaginal, and vesicovaginal dissection, vaginal wound, and vaginal hematoma; and (4) the absence of antibiotic prophylaxis and the absence of an indwelling urethral catheter. All patients required a surgical management, and 55% (n = 10) of them needed two surgeries and 22% (n = 4) had persistent disorders. Procedures should reduce the risk of mesh exposure. Management of mesh exposure should systemically combine radical surgery (i.e., maximal excision of the prosthetic material) and antibiotics cover.