Int Urogynecol J DOI 10.1007/s00192-014-2335-8
LETTER TO THE EDITOR
Mesh retraction correlates with vaginal pain and overactive bladder symptoms after anterior vaginal mesh repair: comment on Rogowski et al B. Jacquetin
# The International Urogynecological Association 2014
Dear Editor, We read with great interest the article by Rogowski et al. about the correlation between vaginal mesh retraction with vaginal pain and, probably for the first time, with overactive bladder symptoms [1]. We would like to add our own experience concerning 91 patients (29 anterior, 16 posterior, and 46 total mesh) with a mean follow-up of 17.9 months, consequently 75 anterior repairs [2]. Our work aimed to compare the subjective clinical evaluation and the objective ultrasonographic (US) measurements and the correlation with prolapse recurrence and pain, because we were, at that time, very concerned by the postoperative pain after pelvic organ prolapse repair with native tissues or with mesh reinforcement [3]. I need to point out that our echographic technique differed; we found that the mesh length measurement Fig. 1 Significant correlation between mesh retraction and mesh thickness
A reply to this comment can be found at doi 10.1007/s00192-014-2334-9. B. Jacquetin (*) Urogynecology Unit, Department of Gynecology-Obstetrics & Human Reproduction, Estaing University Hospital, 1 place Lucie Aubrac, 63003 Clermont-Ferrand cedex 1, France e-mail: [email protected]
was difficult because of the mesh deformation (folded, waved, rolled up in a ball…). Rogowski et al. do not mention these technical difficulties in their study’s limitations. The “ideal” measure of mesh retraction should be the area evaluation, but many authors, particularly Svabik et al. [4], stress the difficulty of getting all the necessary measurements, particularly the transverse ones. It is the reason why we preferred to use the distance from the distal margin of the mesh to an anatomical landmark, the bladder neck for the anterior mesh, but we added two other criteria, the description of mesh deformations and the mesh thickness, evaluating in this way the fibrosis surrounding the mesh. In agreement, we found a significant correlation between mesh retraction and US mesh thickness (Fig. 1).
Int Urogynecol J Fig. 2 Anterior repair; correlation between thickness, aspect, and retraction with vaginal pain (VAS≥5). M mesh, B bladder
Moreover, we found a correlation between mesh retraction and pain intensity, more precisely a thickness ≥ 5 mm with irregular aspect of the mesh at US imaging has a positive predictive value of 94.5 % and a negative predictive value of 100 % of a sensitive shrinkage at vaginal examination (sensitivity 65 % and specificity 100 %) (unpublished data). Figure 2 illustrates examples of the combination of retraction, thickness, and “irregular” aspect of the mesh on vaginal pain [visual analogue scale (VAS)≥5]. Unfortunately, we did not check the concomitant lower urinary tract symptoms, but again it is innovative information provided by the Rogowski et al. paper [1] which confirms the crucial role of US imaging in evaluation of vaginal mesh complications and their management.
References 1. Rogowski A, Bienkowski P, Tosiak A, Jerzak M, Mierzejewski P, Baranowski W (2013) Mesh retraction correlates with vaginal pain and overactive bladder symptoms after anterior vaginal mesh repair. Int Urogynecol J 24:2087–2092. doi:10.1007/s00192-013-2131-x 2. Velemir L, Amblard J, Fatton B, Savary D, Jacquetin B (2010) Transvaginal mesh repair of anterior and posterior vaginal wall prolapse: a clinical and ultrasonographic study. Ultrasound Obstet Gynecol 35:474–480 3. Niro J, Philippe AC, Jaffeux P, Amblard J, Velemir L, Savary D, Jacquetin B, Fatton B (2010) Douleurs postopératoires aprés cure de prolapsus génital par voie vaginale avec ou sans renfort prothétique (Postoperative pain after transvaginal repair of pelvic organ prolapse with or without mesh). Gynecol Obstet Fertil 38:648–652 4. Svabik K, Martan A, Masata J, El-Haddad R, Hubka P, Pavlikova M (2011) Ultrasound appearances after mesh implantation—evidence of mesh contraction or folding? Int Urogynecol J 22:529–533
LETTER TO THE EDITOR
Mesh retraction correlates with vaginal pain and overactive bladder symptoms after anterior vaginal mesh repair: comment on Rogowski et al B. Jacquetin
# The International Urogynecological Association 2014
Dear Editor, We read with great interest the article by Rogowski et al. about the correlation between vaginal mesh retraction with vaginal pain and, probably for the first time, with overactive bladder symptoms [1]. We would like to add our own experience concerning 91 patients (29 anterior, 16 posterior, and 46 total mesh) with a mean follow-up of 17.9 months, consequently 75 anterior repairs [2]. Our work aimed to compare the subjective clinical evaluation and the objective ultrasonographic (US) measurements and the correlation with prolapse recurrence and pain, because we were, at that time, very concerned by the postoperative pain after pelvic organ prolapse repair with native tissues or with mesh reinforcement [3]. I need to point out that our echographic technique differed; we found that the mesh length measurement Fig. 1 Significant correlation between mesh retraction and mesh thickness
A reply to this comment can be found at doi 10.1007/s00192-014-2334-9. B. Jacquetin (*) Urogynecology Unit, Department of Gynecology-Obstetrics & Human Reproduction, Estaing University Hospital, 1 place Lucie Aubrac, 63003 Clermont-Ferrand cedex 1, France e-mail: [email protected]
was difficult because of the mesh deformation (folded, waved, rolled up in a ball…). Rogowski et al. do not mention these technical difficulties in their study’s limitations. The “ideal” measure of mesh retraction should be the area evaluation, but many authors, particularly Svabik et al. [4], stress the difficulty of getting all the necessary measurements, particularly the transverse ones. It is the reason why we preferred to use the distance from the distal margin of the mesh to an anatomical landmark, the bladder neck for the anterior mesh, but we added two other criteria, the description of mesh deformations and the mesh thickness, evaluating in this way the fibrosis surrounding the mesh. In agreement, we found a significant correlation between mesh retraction and US mesh thickness (Fig. 1).
Int Urogynecol J Fig. 2 Anterior repair; correlation between thickness, aspect, and retraction with vaginal pain (VAS≥5). M mesh, B bladder
Moreover, we found a correlation between mesh retraction and pain intensity, more precisely a thickness ≥ 5 mm with irregular aspect of the mesh at US imaging has a positive predictive value of 94.5 % and a negative predictive value of 100 % of a sensitive shrinkage at vaginal examination (sensitivity 65 % and specificity 100 %) (unpublished data). Figure 2 illustrates examples of the combination of retraction, thickness, and “irregular” aspect of the mesh on vaginal pain [visual analogue scale (VAS)≥5]. Unfortunately, we did not check the concomitant lower urinary tract symptoms, but again it is innovative information provided by the Rogowski et al. paper [1] which confirms the crucial role of US imaging in evaluation of vaginal mesh complications and their management.
References 1. Rogowski A, Bienkowski P, Tosiak A, Jerzak M, Mierzejewski P, Baranowski W (2013) Mesh retraction correlates with vaginal pain and overactive bladder symptoms after anterior vaginal mesh repair. Int Urogynecol J 24:2087–2092. doi:10.1007/s00192-013-2131-x 2. Velemir L, Amblard J, Fatton B, Savary D, Jacquetin B (2010) Transvaginal mesh repair of anterior and posterior vaginal wall prolapse: a clinical and ultrasonographic study. Ultrasound Obstet Gynecol 35:474–480 3. Niro J, Philippe AC, Jaffeux P, Amblard J, Velemir L, Savary D, Jacquetin B, Fatton B (2010) Douleurs postopératoires aprés cure de prolapsus génital par voie vaginale avec ou sans renfort prothétique (Postoperative pain after transvaginal repair of pelvic organ prolapse with or without mesh). Gynecol Obstet Fertil 38:648–652 4. Svabik K, Martan A, Masata J, El-Haddad R, Hubka P, Pavlikova M (2011) Ultrasound appearances after mesh implantation—evidence of mesh contraction or folding? Int Urogynecol J 22:529–533
