De novo stress incontinence and pelvic muscle symptoms after transvaginal mesh repair

• Published in: American journal of obstetrics and gynecology Vol. 201; no. 1; pp. 73.e1 - 73.e7
• Main Authors: Aungst, Matthew J., MD, Friedman, Evan B., MD, von Pechmann, Walter S., MD, Horbach, Nicolette S., MD, Welgoss, Jeffrey A., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01-07-2009; Elsevier
• Subjects: Adult; Aged; Biological and medical sciences; dyspareunia; Dyspareunia - etiology; Female; Gynecologic Surgical Procedures; Gynecology. Andrology. Obstetrics; Humans; Intraoperative Complications - epidemiology; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Obstetrics and Gynecology; Postoperative Complications - epidemiology; Postoperative Complications - physiopathology; Prostheses and Implants; Recurrence; Retrospective Studies; stress urinary incontinence; Surgical Mesh; Urinary Incontinence, Stress - epidemiology; Urinary Incontinence, Stress - physiopathology; Urinary system involvement in other diseases. Miscellaneous; Urinary tract. Prostate gland; Urodynamics; uterine prolapse; Uterine Prolapse - surgery; uterine prolapse; dyspareunia; stress urinary incontinence; surgical mesh; Urinary system disease; Gynecology; Urinary tract disease; Obstetrics; De novo; Voiding dysfunction; Symptomatology; Pelvic cavity; Transvaginal route; Bladder disease; Muscle; Repair; Urinary stress incontinence
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/j.ajog.2009.02.028

Objective We sought to determine the rate of de novo stress incontinence, pelvic muscle symptoms, mesh exposure, visceral injury rate, and recurrent prolapse after transvaginal mesh repair. Study Design We conducted a retrospective review of 335 consecutive women with stage II or worse vaginal prolapse who underwent Prolift (Ethicon, Somerville, NJ) between July 7, 2005 and Jan. 31, 2008. Results In all, 71% underwent total Prolift, 20% anterior, and 8% posterior alone. Average age was 62 years and mean follow-up was 8 months. The intraoperative visceral injury rate was 6.6%, mesh exposure rate was 3.8%, and recurrent failure rate was 5.2%. The postoperative de novo stress incontinence rate was 24.3%. In this series, 18% of women had pelvic muscle symptoms postoperatively; 74% of these resolved within 6 months with conservative management. Conclusion After Prolift, surgeons can expect a low rate of recurrent prolapse and mesh exposure. However, pelvic muscle dysfunction and de novo stress incontinence will be encountered postoperatively in a moderate number of women.