No Treatment Required for Asymptomatic Vaginal Mesh Exposure

There is no specific recommendation for the management of asymptomatic vaginal mesh erosions post antiincontinence or prolapse surgery, but revision or excision may represent overtreatment. We hypothesize that asymptomatic vaginal exposures remain asymptomatic during follow-up and do not require any intervention.

We evaluated a "no treatment" approach by prospectively following-up women with asymptomatic vaginal exposures after antiincontinence and pelvic organ prolapse surgery. After a 1-month course of vaginal oestrogen, they underwent the "wait and see" protocol. It consisted of no treatment. Women were followed-up every 3 months, for the first year and then every 6 months with history, clinical examination with measurement of size of the exposure, and the evaluation of possible infection signs or vaginal discharge.

Forty women were followed-up for a median of 33.52 months (range 8-48 months). All exposures were ≤1 cm (mean 6.5 ± 1.5 mm, range 4-10 mm), patients were asymptomatic and without pain. During the observation period, the size of the exposure did not change and all women remained asymptomatic.

No treatment seems to be required for asymptomatic and small vaginal mesh exposures after prolapse or incontinence surgery.