Risk factors for mesh/suture erosion following sacral colpopexy

• Published in: American journal of obstetrics and gynecology Vol. 199; no. 6; pp. 688.e1 - 688.e5
• Main Authors: Cundiff, Geoffrey W., MD, Varner, Edward, MD, Visco, Anthony G., MD, Zyczynski, Halina M., MD, Nager, Charles W., MD, Norton, Peggy A., MD, MS, Schaffer, Joseph, MD, Brown, Morton B., PhD, Brubaker, Linda, MD, MS
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York, NY Mosby, Inc 01.12.2008; Elsevier
• Subjects: Adult; Aged; Biological and medical sciences; CARE trial; Colposcopy - adverse effects; Colposcopy - methods; expanded polytrafluroethylene (Gore-Tex, GORE Medical, Newark, DE); Female; Follow-Up Studies; Gynecologic Surgical Procedures - methods; Gynecology. Andrology. Obstetrics; Humans; hysterectomy; Medical sciences; mesh erosion; Middle Aged; Obstetrics and Gynecology; Prosthesis Design; Prosthesis Failure; Reoperation; Risk Factors; sacral colpopexy; Severity of Illness Index; Surgical Mesh - adverse effects; Sutures - adverse effects; Urinary Incontinence, Stress - etiology; Urinary Incontinence, Stress - physiopathology; Urinary Incontinence, Stress - surgery; Uterine Prolapse - complications; Uterine Prolapse - diagnosis; Uterine Prolapse - surgery; expanded polytrafluroethylene (Gore-Tex, GORE Medical, Newark, DE); mesh erosion; CARE trial; hysterectomy; sacral colpopexy; Sacrum; Treatment; Surgery; Gynecology; Risk factor; Obstetrics; Colpopexy; Erosion; Suture
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/j.ajog.2008.07.029

Objective The purpose of this study was to identify risks for mesh/suture erosions following abdominal sacral colpopexy (ASC). Study Design We analyzed demographic, perioperative variables, and erosion status in 322 participants in the Colpopexy and Urinary Reduction Efforts study 2 years after sacral colpopexy. Results The predominant graft used was synthetic mesh: woven polyester (Mersilene; Ethicon, Inc, Somerville, NJ) (42%) or polypropylene (48%). Twenty subjects (6%) experienced mesh/suture erosion. Unadjusted risk factors for mesh/suture erosion were expanded polytrafluroethylene (ePTFE) mesh (ePTFE 4/21 [19%] vs non-ePTFE 16/301 [5%]; odds ratio [OR], 4.2), concurrent hysterectomy (OR, 4.9), and current smoking (OR, 5.2). Of those with mesh erosion, most affected women (13/17) underwent at least 1 surgery for partial or total mesh removal. Two were completely resolved, 6 had persistent problems, and 5 were lost to follow-up. No resolution was documented in the 4 women who elected observation. Conclusion Expanded PTFE mesh should not be used for sacral colpopexy. Concurrent hysterectomy and smoking are modifiable risks for mesh/suture erosion.