Clinical Characteristics of Patients with Mesh or Sling Exposure: A Single-center Retrospective Study

Abstract Objectives: This study aims to (1) summarize the chief complaints related to mesh exposure, offering insights for clinical identification; (2) detail the clinical characteristics of mesh exposure using the Category-Time-Section (CTS) system; and (3) describe the management and outcomes of mesh exposure to offer evidence for guidance and shared opinions for other surgeons. Design: Single-center retrospective study Setting: We analyzed data of mesh or sling exposure patients clinically collected by our hospital during January 2008 to January 2020. Analysis was performed on the basic information, primary operation for pelvic organ prolapse (POP) or stress urinary incontinence (SUI), chief complaint, CTS classification, treatment and outcome for mesh or sling exposure. Population: Patients who visited our hospital between January 2008 and January 2020 and were clinically confirmed with problematic mesh or sling exposure, with complete medical records. Results: A total of 71 women were included in this study, whose median age was 56 years. Twenty of those patients (28.17%) underwent transvaginal mesh (TVM) for POP. The most common chief complaint was vaginal bleeding (40/71, 56.34%). Category 2 (49.30%) and Category 3 (46.48%) were the predominant CTS categories. The majority of those patients were identified to have mesh exposures in 12 months post-surgery. Thirty-nine (39) patients (54.93%) underwent multiple procedures to address mesh or sling exposure. Conclusion: Vaginal bleeding and pain can be indictive symptoms for mesh exposures. Most of the symptomatic exposures are category 2 and category 3. Mesh or sling exposures initiates most frequently in 12 months post-surgery and localize predominantly at the vaginal suture area. Majority of patients were initially treated with non-surgical approaches and eventually required surgical intervention. Non-surgical approaches can be adopted as initial preservative treatment for patients who were asymptomatic and had exposure smaller than 1cm . Key words: transvaginal mesh; mid-urethral sling; pelvic organ prolapse; stress urinary incontinence; exposure