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Management of transvaginal mesh exposure and pain following pelvic surgery

Authors
John B Gebhart, MD, MS
Emanuel C Trabuco, MD, MS
Section Editor
Linda Brubaker, MD, FACS, FACOG
Deputy Editor
Kristen Eckler, MD, FACOG

INTRODUCTION

Vaginal synthetic mesh is inserted to augment native tissue; however, these materials have been associated with numerous complications including mesh exposure, perforation, or contraction; pelvic pain; dyspareunia; infection; urinary and bowel dysfunction; and fistula formation [1-5]. This topic will discuss the diagnosis and management of exposure (erosion) and pain resulting from vaginal mesh insertion. Other types of mesh complications are reviewed separately. (See "Overview of transvaginal placement of mesh for prolapse and stress urinary incontinence", section on 'Complications'.)

MESH EXPOSURE

Clinical findings and diagnosis — Patients may present with mesh exposure, vaginal bleeding, pelvic pain, dyspareunia, and partner irritation during sex [5,6]. Some patients feel the mesh themselves. Rare patients with mesh exposure are asymptomatic. The prevalence of symptom type varies by indication for surgery (incontinence versus prolapse), anatomic location of mesh (suburethral, anterior, apical, or posterior), and mode of insertion (transvaginal mesh versus mesh kits). The most common symptoms have a wide prevalence range, but are consistently present in at least 10 percent of patients and include [1,6-12]:

Pelvic or vaginal pain

Mesh exposure

Dyspareunia

                    

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Literature review current through: Nov 2016. | This topic last updated: Tue Nov 29 00:00:00 GMT 2016.
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References
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