Instructional Course - Requires Course Pass or Individual Course Ticket, Additional Registration Required
Despite being standards in the treatment of pelvic floor disorders, synthetic mesh implants are associated with unique complications which require expert evaluation and careful management. Although many surgeons are turning to alternative methods of reconstruction without mesh, the surgical treatment of mesh complications continues to increase.
Complications from mesh placed for anti-incontinence procedures and transvaginal/abdominal pelvic organ prolapse repair include vaginal mesh extrusion; urethral, bladder, vascular, or bowel perforation; pelvic pain and dyspareunia. The relative risks and presentation can vary depending on the approach and type of implant. In addition to reviewing the evidence, photos of complications and photos and videos of surgical management of complications are covered. We also review the management of patients with recurrent incontinence and/or prolapse after mesh excision for complications including non-mesh alternatives and evidence-based outcomes.
Ongoing controversies in mesh are covered which affect our patients. The evidence for and against mesh degradation, microbial mesh infections, and the concept of "radical meshectomy" are debated. We present a practical and evidence-based algorithm for counseling and treatment regarding mesh excision for pain alone. Finally, we discuss appropriate patient selection, counseling, and surgical techniques for mesh implanters to reduce the risk of complication and litigation.