TY - JOUR
T1 - Seeking new surgical predictors of mesh exposure after transvaginal mesh repair
AU - Wu, Pei Ying
AU - Chang, Chih Hung
AU - Shen, Meng Ru
AU - Chou, Cheng Yang
AU - Yang, Yi Ching
AU - Huang, Yu Fang
N1 - Publisher Copyright:
© 2016, The International Urogynecological Association.
PY - 2016/10/1
Y1 - 2016/10/1
N2 - Introduction and hypothesis: The purpose of this study was to explore new preventable risk factors for mesh exposure. Methods: A retrospective review of 92 consecutive patients treated with transvaginal mesh (TVM) in the urogynecological unit of our university hospital. An analysis of perioperative predictors was conducted in patients after vaginal repairs using a type 1 mesh. Mesh complications were recorded according to International Urogynecological Association (IUGA) definitions. Mesh-exposure-free durations were calculated by using the Kaplan−Meier method and compared between different closure techniques using log-rank test. Hazard ratios (HR) of predictors for mesh exposure were estimated by univariate and multivariate analyses using Cox proportional hazards regression models. Results: The median surveillance interval was 24.1 months. Two late occurrences were found beyond 1 year post operation. No statistically significant correlation was observed between mesh exposure and concomitant hysterectomy. Exposure risks were significantly higher in patients with interrupted whole-layer closure in univariate analysis. In the multivariate analysis, hematoma [HR 5.42, 95 % confidence interval (CI) 1.26–23.35, P = 0.024), Prolift mesh (HR 5.52, 95 % CI 1.15–26.53, P = 0.033), and interrupted whole-layer closure (HR 7.02, 95 % CI 1.62–30.53, P = 0.009) were the strongest predictors of mesh exposure. Conclusion: Findings indicate the risks of mesh exposure and reoperation may be prevented by avoiding hematoma, large amount of mesh, or interrupted whole-layer closure in TVM surgeries. If these risk factors are prevented, hysterectomy may not be a relative contraindication for TVM use. We also provide evidence regarding mesh exposure and the necessity for more than 1 year of follow-up and preoperative counselling.
AB - Introduction and hypothesis: The purpose of this study was to explore new preventable risk factors for mesh exposure. Methods: A retrospective review of 92 consecutive patients treated with transvaginal mesh (TVM) in the urogynecological unit of our university hospital. An analysis of perioperative predictors was conducted in patients after vaginal repairs using a type 1 mesh. Mesh complications were recorded according to International Urogynecological Association (IUGA) definitions. Mesh-exposure-free durations were calculated by using the Kaplan−Meier method and compared between different closure techniques using log-rank test. Hazard ratios (HR) of predictors for mesh exposure were estimated by univariate and multivariate analyses using Cox proportional hazards regression models. Results: The median surveillance interval was 24.1 months. Two late occurrences were found beyond 1 year post operation. No statistically significant correlation was observed between mesh exposure and concomitant hysterectomy. Exposure risks were significantly higher in patients with interrupted whole-layer closure in univariate analysis. In the multivariate analysis, hematoma [HR 5.42, 95 % confidence interval (CI) 1.26–23.35, P = 0.024), Prolift mesh (HR 5.52, 95 % CI 1.15–26.53, P = 0.033), and interrupted whole-layer closure (HR 7.02, 95 % CI 1.62–30.53, P = 0.009) were the strongest predictors of mesh exposure. Conclusion: Findings indicate the risks of mesh exposure and reoperation may be prevented by avoiding hematoma, large amount of mesh, or interrupted whole-layer closure in TVM surgeries. If these risk factors are prevented, hysterectomy may not be a relative contraindication for TVM use. We also provide evidence regarding mesh exposure and the necessity for more than 1 year of follow-up and preoperative counselling.
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U2 - 10.1007/s00192-016-2996-6
DO - 10.1007/s00192-016-2996-6
M3 - Article
C2 - 26992722
AN - SCOPUS:84961210832
SN - 0937-3462
VL - 27
SP - 1547
EP - 1555
JO - International Urogynecology Journal
JF - International Urogynecology Journal
IS - 10
ER -