Seeking new surgical predictors of mesh exposure after transvaginal mesh repair

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)1547-1555
Number of pages9
JournalInternational Urogynecology Journal
Volume27
Issue number10
DOIs
Publication statusPublished - 2016 Oct 1

Fingerprint

Surgical Mesh
Confidence Intervals
Hysterectomy
Hematoma
Multivariate Analysis
Reoperation
Proportional Hazards Models
Counseling

All Science Journal Classification (ASJC) codes

  • Obstetrics and Gynaecology
  • Urology

Cite this

@article{62c1d62d0c4d494783be769fd81810b6,
title = "Seeking new surgical predictors of mesh exposure after transvaginal mesh repair",
abstract = "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.",
author = "Pei-Ying Wu and Chang, {Chih Hung} and Meng-Ru Shen and Cheng-Yang Chou and Yi-Ching Yang and Yu-Fang Huang",
year = "2016",
month = "10",
day = "1",
doi = "10.1007/s00192-016-2996-6",
language = "English",
volume = "27",
pages = "1547--1555",
journal = "International Urogynecology Journal and Pelvic Floor Dysfunction",
issn = "0937-3462",
publisher = "Springer London",
number = "10",

}

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

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.

UR - http://www.scopus.com/inward/record.url?scp=84961210832&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84961210832&partnerID=8YFLogxK

U2 - 10.1007/s00192-016-2996-6

DO - 10.1007/s00192-016-2996-6

M3 - Article

C2 - 26992722

AN - SCOPUS:84961210832

VL - 27

SP - 1547

EP - 1555

JO - International Urogynecology Journal and Pelvic Floor Dysfunction

JF - International Urogynecology Journal and Pelvic Floor Dysfunction

SN - 0937-3462

IS - 10

ER -