Podium Session

Poster, Podium & Video Sessions

PD17-10: VAGINAL MESH REMOVAL OUTCOMES: EIGHT YEARS OF EXPERIENCE AT AN ACADEMIC HOSPITAL

Saturday, May 13
8:30 AM - 8:40 AM
Location: BCEC: Room 161

Presentation Authors: Olivia O. Cardenas-Trowers*, Pouran Malekzadeh, David E. Nix, Kenneth D. Hatch, Tucson, AZ

Introduction: There is much data in the literature about the complications of vaginal mesh; however, there is much less addressing the clinical outcomes for patients who undergo vaginal mesh removal due to complications from their mesh. The objective of this study is to describe the clinical history leading up to as well as the outcomes after vaginal mesh removal surgery at an academic, tertiary care hospital.

Methods: A retrospective study of patients who underwent vaginal mesh removal from 2008 to 2015. Demographics, clinical history, physical exam, pre- and post-operative symptoms, and number of re-operations were abstracted. Fisher&[prime]s exact test with significance at p<0.05 was used for comparative statistics.

Results: Between February 2008 and November 2015, 84 patients underwent vaginal mesh removal at our hospital. The median time interval from initial mesh placement to removal was 58 months (range 0.4 to 154 months). Most patients (n=61, 73%) had no prior history of mesh removal surgery. The most common pre-operative symptoms were vaginal pain (n=52, 62%), dyspareunia (n= 46, 55%), and pelvic pain (n=42, 50%). Intraoperative complications were infrequent with injury to the urethra, bladder, and bowel occurring in 1 patient each (n=3, 4%). Of patients presenting for follow up within 4-6 weeks post-operatively, 45 (83%) were deemed better than before surgery. Pre-operative symptoms that improved by six weeks or greater following mesh removal surgery were mesh erosion (p<.0001), vaginal pain (p<.0001), vaginal bleeding (p=0.0028), vaginal discharge (p=0.0127), dyspareunia (p=0.0024), and pelvic pain (p=0.0005). There were no identifiable risk factors to predict which patients would have persistent post-operative symptoms or who would require more than one mesh removal surgery. After vaginal mesh removal, 29 patients (35%) required one or more re-operations with 3 being the highest number of reoperations.

Conclusions: Vaginal mesh removal surgery is safe and can alleviate many pre-operative symptoms. Some patients require more than one procedure and the risk factors for reoperations are unclear.

Source Of Funding: None

Olivia O. Cardenas-Trowers, MD

University of Arizona

Olivia Cardenas-Trowers, M.D. is currently a third year Obstetrics and Gynecology resident at the University of Arizona in Tucson, AZ. She received her B.A. in Human Biology with a concentration in Health and Fitness at Stanford University in 2010. She graduated with a medical degree from Meharry Medical College in 2014.

Dr. Cardenas-Trowers is invested in female pelvic medicine and reconstructive surgery (FPMRS) and is currently pursuing fellowship in FPMRS. She has many research interests and is the primary investigator of many projects focusing on female pelvic health including outcomes of vaginal mesh removal, minimally invasive repair of genito-urinary fistulas, use and route of hormones and the association with pelvic floor disorders in pre- and post-menopausal women, and laparoscopic simulation to improve training in pelvic floor surgeries. She plans on continuing her research in her future role as an academic urogynecologist.

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