Management of mesh complications following surgery for stress urinary incontinence or pelvic organ prolapse: a systematic review.
Adolescent
Adult
Aged
Blood Loss, Surgical
Dyspareunia
/ etiology
Female
Humans
Intraoperative Complications
/ etiology
Middle Aged
Patient Satisfaction
Pelvic Organ Prolapse
/ surgery
Postoperative Complications
/ etiology
Quality of Life
Recurrence
Sexual Dysfunction, Physiological
/ etiology
Surgical Mesh
/ adverse effects
Treatment Outcome
Urinary Incontinence, Stress
/ surgery
Young Adult
Mesh revision
pelvic organ prolapse
stress urinary incontinence
Journal
BJOG : an international journal of obstetrics and gynaecology
ISSN: 1471-0528
Titre abrégé: BJOG
Pays: England
ID NLM: 100935741
Informations de publication
Date de publication:
01 2020
01 2020
Historique:
accepted:
29
08
2019
pubmed:
22
9
2019
medline:
24
12
2019
entrez:
22
9
2019
Statut:
ppublish
Résumé
Mesh surgery for stress urinary incontinence or pelvic organ prolapse can result in complications such as mesh exposure, mesh extrusion, voiding dysfunction, dyspareunia, and pain. There is limited knowledge or guidance on the effective management for mesh-related complications. To determine the best management of mesh complications; a systematic review was conducted as part of the national clinical guideline 'Urinary incontinence (update) and pelvic organ prolapse in women: management'. Search strategies were developed for each indication for referral. Relevant interventions included complete or partial mesh removal, mesh division, and non-surgical treatments such as vaginal estrogen. Characteristics and outcome data were extracted, and as a result of the heterogeneous nature of the data a narrative synthesis was conducted. Twenty-four studies were included; five provided comparative data and four studies stated the indication for referral. Reported outcomes (including pain, dyspareunia, satisfaction, quality of life, incontinence, mesh exposure, and recurrence) and the reported incidences of these varied widely. The current evidence base is limited in quantity and quality and does not permit firm recommendations to be made on the most effective management for mesh-related complications. Robust data are needed so that mesh complications can be managed effectively in the future. Systematic review demonstrates that the outcomes following mesh revision surgery are highly variable.
Sections du résumé
BACKGROUND
Mesh surgery for stress urinary incontinence or pelvic organ prolapse can result in complications such as mesh exposure, mesh extrusion, voiding dysfunction, dyspareunia, and pain. There is limited knowledge or guidance on the effective management for mesh-related complications.
OBJECTIVE
To determine the best management of mesh complications; a systematic review was conducted as part of the national clinical guideline 'Urinary incontinence (update) and pelvic organ prolapse in women: management'.
SEARCH STRATEGY
Search strategies were developed for each indication for referral.
SELECTION CRITERIA
Relevant interventions included complete or partial mesh removal, mesh division, and non-surgical treatments such as vaginal estrogen.
DATA COLLECTION AND ANALYSIS
Characteristics and outcome data were extracted, and as a result of the heterogeneous nature of the data a narrative synthesis was conducted.
MAIN RESULTS
Twenty-four studies were included; five provided comparative data and four studies stated the indication for referral. Reported outcomes (including pain, dyspareunia, satisfaction, quality of life, incontinence, mesh exposure, and recurrence) and the reported incidences of these varied widely.
CONCLUSIONS
The current evidence base is limited in quantity and quality and does not permit firm recommendations to be made on the most effective management for mesh-related complications. Robust data are needed so that mesh complications can be managed effectively in the future.
TWEETABLE ABSTRACT
Systematic review demonstrates that the outcomes following mesh revision surgery are highly variable.
Identifiants
pubmed: 31541614
doi: 10.1111/1471-0528.15958
doi:
Types de publication
Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
28-35Subventions
Organisme : National Institute for Health and Care Excellence (NICE)
Pays : International
Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2019 Royal College of Obstetricians and Gynaecologists.
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