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Updated: Aug 19, 2025
Transvaginal Mesh Insertion in the Ovine Model
Published on: July 27, 2017
Transvaginal Mesh-related Complications and the Potential Role of Bacterial Colonization: An Exploratory
Chantal M Diedrich1, Kim W J Verhorstert1, Martijn Riool2
1Department of Obstetrics and Gynecology, Amsterdam Reproduction and Development, Amsterdam UMC, University of Amsterdam, Meibergdreef 9 (Drs. Diedrich, Verhorstert, Schuster, and Roovers), Amsterdam, The Netherlands; Department of Medical Microbiology and Infection Prevention, Amsterdam institute for Infection and Immunity, Amsterdam UMC, University of Amsterdam, Meibergdreef 9 (Drs. Diedrich, Verhorstert, Riool, Zaa, and Schuster, Ms. de Boer), Amsterdam, The Netherlands.
Study Objective:
This study aimed to investigate the potential role of transvaginal mesh bacterial colonization in the development of mesh-related complications (MRCs).
Design:
An observational and exploratory study.
Setting:
Tertiary referral center (Amsterdam UMC, location AMC, Amsterdam, The Netherlands). PATIëNTS: 49 patients indicated for mesh removal and 20 women of whom vaginal tissue was retrieved during prolapse surgery as a reference cohort.
Interventions:
collection of mesh-tissue complex (patient cohort) or vaginal tissue (reference cohort) MEASUREMENTS AND MAIN RESULTS: Homogenized samples were used for quantitative microbiological culture. Inflammation and fibrosis were semiquantitatively histologically scored; Gram staining and fluorescence in situ hybridization were used to detect bacteria and bacterial biofilms. Of the 49 patients, 44 samples (90%) were culture positive, with a higher diversity of species and more Gram-negative bacteria and polymicrobial cultures in the MRC cohort than the reference cohort, with mostly staphylococci, streptococci, Actinomyces spp., Cutibacterium acnes, and Escherichia coli. Patients with clinical signs of infection or exposure had the highest bacterial counts. Histology demonstrated moderate to severe inflammation in most samples. Gram staining showed bacteria in 57% of culture-positive samples, and in selected samples, fluorescence in situ hybridization illustrated a polymicrobial biofilm.
Conclusion:
In this study, we observed distinct differences in bacterial numbers and species between patients with MRCs and a reference cohort. Bacteria were observed at the mesh-tissue interface in a biofilm. These results strongly support the potential role of bacterial mesh colonization in the development of MRCs.
Insights
Bacterial colonization of transvaginal mesh may cause mesh-related complications (MRCs). This study found higher bacterial diversity and counts in patients with MRCs compared to a reference group, suggesting a role for biofilms.
Area of Science:
- Gynecology
- Microbiology
- Pathology
Background:
- Transvaginal mesh is used for pelvic organ prolapse repair.
- Mesh-related complications (MRCs) are a significant concern.
- The role of bacterial colonization in MRC development is not fully understood.
Purpose of the Study:
- To investigate the presence and characteristics of bacterial colonization on transvaginal mesh.
- To determine if bacterial colonization differs between patients with and without MRCs.
- To explore the association between bacterial load, species, and MRCs.
Main Methods:
- Observational study involving 49 patients undergoing mesh removal and 20 controls.
- Collection of mesh-tissue complexes and vaginal tissue samples.
- Quantitative microbiological cultures, histological scoring for inflammation/fibrosis, Gram staining, and fluorescence in situ hybridization (FISH) for bacteria and biofilms.
Main Results:
- 90% of mesh samples showed bacterial growth, with higher diversity and Gram-negative bacteria in the MRC group.
- Common bacteria included staphylococci, streptococci, Actinomyces spp., Cutibacterium acnes, and Escherichia coli.
- Histology revealed inflammation, and FISH confirmed polymicrobial biofilms at the mesh-tissue interface.
Conclusions:
- Distinct differences in bacterial presence and species exist between patients with MRCs and controls.
- Bacteria are present at the mesh-tissue interface, often within biofilms.
- These findings support the hypothesis that bacterial mesh colonization contributes to the development of MRCs.
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