Managing vaginal mesh exposure/erosions

摘要

Purpose of Review: To review the known causes, presentation, and management of synthetic mesh exposure and other healing abnormalities associated with transvaginal implantation for pelvic organ prolapse. Recent Findings: The recent restriction of mesh used in urogynecology to type 1 monofilament/macroporous mesh has led to recognizable patterns of healing abnormality development. Excision of exposed or contracted mesh segments usually leads to symptom resolution. There are various surgical techniques recognized to reduce the risk of exposure development. Pain, when associated with mesh use, may be more challenging to manage and may persist in a small percentage of patients. Surgeons should be aware of recently recognized risk factors for exposure development and carefully select patients for mesh implantation based on risk:benefit assessment. Summary: The use of synthetic mesh implanted transvaginally for urogynecologic indications is associated with recognized risks, including exposure (approximately 10%) and contraction which can usually be managed successfully with local estrogen, in-office trimming, or surgical excision of the exposed or contracted segment.