[Treatment and outcome of polypropylene mesh or tape related pain after reconstructive pelvic surgery]

Objective: To investigate clinical treatment and outcome of mesh-related pain after pelvic floor reconstruction. Methods: Twelve patients were referred to Peking University People's Hospital for post-operation pain related to polypropylene mesh or tape used in pelvic floor reconstruction and received reoperation from January 2007 to December 2014. The demographic characteristics, clinical manifestation, operation method and follow-up outcome were retrospectively analyzed, and current literature was also reviewed. Results: (1) General information: the median age was 54 years old (range 43-74 years old). The median vaginal delivery times was 2 (range 1-5). Initial pelvic floor operation procedures included 4 cases vaginal mesh, 5 cases vaginal mesh plus tension-free vaginal tape (TVT), 1 case rectal surface mesh implantation, and 2 cases sacrocolpopexy. (2) Related complications: all 12 patients had pain-related post-operation symptoms including dyspareunia, perineal pain, urination and defecation difficulty. Seven patients also complicated with other symptoms including discharge and bleeding. Mean time from first operation to medical consultation was 30 months (range 1-72 months). (3) Reoperation results: all 12 patients received reoperation on mesh revision or tape, 10 cases of them reoperated by vaginal approach, while the other 2 cases by laparoscopy. The range of the mesh or tape depended on tender or firm tissue and scar by palpation. The visual analogue scale (VAS) was significantly improved, which was 7.1 ± 2.2 pre-operation, and 0.9 ± 1.9 post-operation (95% CI: 4.48-7.86, P<0.01). Conclusions: Pain is one of the reason why patients was removal of the mesh or tape after pelvic floor reconstruction operation. The surgery procedure may be considered as partial or entire mesh or tape excision by vaginal or abdominal way. Mesh or tape removal surgery could relieve related pain and other complications, and the VAS score was significantly improved after surgical management.