Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Management of Mesh Complications in Gynecologic Surgery

Obstet Gynecol; ePub 2017 Apr 10; ACOG, AUGS

The American College of Obstetricians and Gynecologists (ACOG) and the American Urogynecologic Society (AUGS) have jointly developed a committee opinion of the management of mesh and graft complications in gynecologic surgery. The purpose of this document is to provide obstetrician–gynecologists with guidance on how to manage simple mesh complications. It also suggests when referral to a clinician with appropriate training and experience, such as a female pelvic medicine and reconstructive surgery specialist, is indicated for mesh complications related to vaginal prolapse surgery. Recommendations from the ACOG and AUGS include the following:

  • Short-term voiding dysfunction after placement of a synthetic midurethral sling is common and, if improving, can be managed expectantly for up to 6 weeks. However, retention or small-volume voids with large postvoid bladder residual volume should receive earlier intervention.
  • Asymptomatic exposures of monofilament macroporous meshes can be managed expectantly.
  • A trial of vaginal estrogen can be attempted for small (eg, less than 0.5-cm) mesh exposures.
  • Persistent vaginal bleeding, vaginal discharge, or recurrent urinary tract infections (UTIs) after mesh placement should prompt an examination and possible further evaluation for exposure or erosion.
  • Pelvic pain (including dyspareunia), possibly related to nonexposed mesh, is complex, may not respond to mesh removal, and should prompt referral to a clinician with appropriate training and experience, such as a female pelvic medicine and reconstructive surgery specialist.
  • Mesh removal surgery should not be performed unless there is a specific therapeutic indication.

Citation:

Management of mesh and graft complications in gynecologic surgery. Committee Opinion No. 694. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2017;129:e102–8.