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Delay in Diagnosis of Mesh-Related Lower Urinary Tract Complications Results in Prolonged Patient Morbidity in a Rural Population
Richard T. Kershen, MD.
University of Vermont/FAHC, Burlington, VT, USA.
BACKGROUND:
The availability and marketing of minimally invasive synthetic polypropylene mesh kits for the correction of stress urinary incontinence and pelvic organ prolapse has resulted in their widespread usage by urologists and gynecologists alike. Mesh-related lower urinary tract (LUT) complications including bladder outlet obstruction (BOO) and entry/erosion into the bladder or urethra may present with a variety of early and sometimes subtle symptoms. A high index of suspicion must be maintained for prompt diagnosis of these complications, as delay will prolong patient suffering and potentially result in irreversible changes in LUT function. We sought to evaluate timeliness of diagnosis and treatment of mesh-related lower urinary tract complications in a rural patient population served by a tertiary care referral center.
METHODS:
This is a retrospective review of all patients referred to our center with transvaginal mesh-related LUT complications who underwent surgical removal over a 6-year period. Non-LUT related mesh complications such as vaginal extrusion, infection, and/or vaginal or pelvic pain were excluded from analysis. Patients diagnosed with a mesh-related LUT complication needed to have LUT symptoms (S) related to BOO or mesh entry/erosion into the LUT.
RESULTS:
Twenty patients with mesh-related LUT complications were treated between November 2005 and September 2011. Eight patients had refractory LUTS found to be related to BOO. Twelve patients had LUTS related to mesh entry into the LUT. The majority (85%) of patients with LUT complications developed symptoms within 3 months (mos.) of mesh implantation. The remaining 15% developed symptoms within 6-12 mos. of surgery. The average amount of time between mesh insertion and removal was 28.6 mos. (range: 4-77 mos.; median: 28 mos.).
CONCLUSIONS:
Symptoms suggestive of a LUT complication related to vaginal mesh commonly present within 3 mos. of implantation. In a rural patient population, definitive diagnosis and treatment of these complications is delayed by more than two years on average. Improved education of mesh-implanting physicians on how to suspect and diagnose these complications earlier will prevent prolonged patient suffering, and potentially avoid the development of permanent LUT dysfunction.
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