University College London, London, UK.
University College London Hospitals NHS Foundation Trust, 235, Euston Road, London, NW1 2BU, UK.
BMC Womens Health. 2024 Nov 1;24(1):585. doi: 10.1186/s12905-024-03393-5.
Over the last two decades one of the main surgical treatment for stress urinary incontinence (SUI) and pelvic organ prolapse (POP) surgery was the insertion of non-absorbable mesh to restore continence and prolapse respectively. Over time complications arose including mesh-associated pain syndrome (MAPS), mesh exposure, mesh, erosion, chronic bladder/vaginal infections, and dyspareunia. Consequently, women chose surgical mesh removal to counter these problems. However, little is known about the demographics, medical co-morbidities, mesh types involved and the timing from mesh insertion to mesh removal. This retrospective study will look at which of these factors may be closely associated with mesh removal surgery.
Retrospective evaluation.
Female Pelvic Medicine and Reconstructive Surgery (FPMRS) Clinic at University College London Hospitals NHS Foundation Trust.
All patients presenting to the FPMRS Clinic between June 2011 to December 2019, requesting mesh removal surgery with a history of MAPS and other mesh complications were included in this study.
Patient demographics including age, ethnicity, obstetric history, and medical co-morbidities; type of mesh/anatomical route used; onset of symptoms; and time from insertion to removal were recorded.
Determination of correlation coefficients between patient demographics, patient reported symptoms and mesh removal surgery.
Three hundred and forty-five women with a history of MAPS were included in the study. Women in the 40-60 year old cohort accounted for 54.4% of mesh removal surgery; 54.8% had a BMI under 30 and almost 90% were Caucasian. 96.5% had had children, with over 77% having had a vaginal delivery. 91.9% of patients reported other health conditions including 18.8% with a concomitant history of mental health problems and 15.4% with a history of heart disease. Over 80% of women undergoing mesh removal surgery had a continence mesh (49% retropubic and 32% obturator continence mesh) removed, whereas 20% had an abdominal prolapse and/or vaginal prolapse mesh removed. The average time from mesh insertion to mesh removal was seven years, with the prevalence of mesh removal surgery averaging 85% (range 50-100%) depending on the comorbidity determined.
All women presented to the clinic with a history of MAPS and other comorbidities which may have influenced their decision to pursue mesh removal surgery. There were no specific predictors, other than chronic pain associated with mesh, determining which women underwent surgery, though those with continence mesh were more likely to do so.
在过去的二十年中，压力性尿失禁（SUI）和盆腔器官脱垂（POP）手术的主要外科治疗之一是插入不可吸收的网片，分别恢复尿失禁和脱垂。随着时间的推移，出现了并发症，包括网片相关疼痛综合征（MAPS）、网片暴露、网片侵蚀、慢性膀胱/阴道感染和性交困难。因此，女性选择进行网片移除手术来解决这些问题。然而，对于网片移除手术的相关因素，例如人口统计学、合并症、网片类型以及从网片插入到移除的时间等，我们知之甚少。本回顾性研究将探讨这些因素中哪些可能与网片移除手术密切相关。
回顾性评估。
伦敦大学学院医院 NHS 基金会信托基金女性盆底医学和重建外科（FPMRS）诊所。
所有于 2011 年 6 月至 2019 年 12 月期间因 MAPS 和其他网片并发症就诊于 FPMRS 诊所并要求进行网片移除手术的女性患者均纳入本研究。
记录患者人口统计学资料，包括年龄、种族、产科史和合并症；使用的网片/解剖途径类型；症状出现时间；以及从插入到移除的时间。
确定患者人口统计学、患者报告的症状与网片移除手术之间的相关系数。
本研究共纳入 345 例患有 MAPS 病史的女性。40-60 岁年龄组的女性占网片移除手术的 54.4%；54.8%的患者 BMI 低于 30，近 90%为白种人。96.5%的患者有生育史，其中 77%以上为阴道分娩。91.9%的患者报告存在其他健康状况，包括 18.8%合并心理健康问题和 15.4%合并心脏病。超过 80%的行网片移除手术的女性移除了用于治疗尿失禁的网片（49%为耻骨后网片，32%为闭孔尿道支持网片），而 20%的女性移除了用于治疗盆腔或阴道脱垂的网片。从网片插入到网片移除的平均时间为 7 年，网片移除手术的患病率平均为 85%（范围为 50%-100%），取决于确定的合并症。
所有就诊于该诊所的女性均有 MAPS 病史和其他合并症，这些可能影响了她们进行网片移除手术的决定。除了与网片相关的慢性疼痛外，没有特定的预测因素决定哪些女性接受手术，但有尿失禁网片的女性更有可能接受手术。
