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Updated: Jun 7, 2025
Laparoscopic Non-Mesh Cerclage Pectopexy for Pelvic Organ Prolapse
Published on: September 13, 2022
Management of Sacrocolpopexy Mesh Complications-A Narrative Review and Clinical Experience from a Large-Volume Center
Chen Shenhar1,2, Howard B Goldman3
1Urogynecology and Reconstructive Pelvic Surgery, Glickman Urologic Institute and Lerner College of Medicine, Cleveland Clinic, Cleveland, OH, USA. g.shenhar@gmail.com.
Introduction And Hypothesis:
Despite the reputation of sacrocolpopexy as a highly durable reconstructive surgery for pelvic organ prolapse, mesh-related complications remain a significant deterrent for patients. This review discusses the incidence, presentation, diagnosis, management and prevention of sacrocolpopexy mesh complications.
Methods:
We reviewed the literature on sacrocolpopexy focusing on long-term mesh complications and their management. As the literature is not specifically robust, we also give our recommendations based on experience from a large-volume center. Intraoperative videos and images are provided to illustrate findings and management techniques.
Results:
Sacrocolpopexy mesh complications include vaginal mesh exposure; bladder or bowel erosions; inflammatory and infectious conditions including spondylodiscitis; and mesh-related pain. Presentation ranges from overt symptoms such as mesh palpated in the vagina to insidious-like spondylodiscitis manifesting as back pain and malaise. Diagnosis relies on methodical history taking, review of operative reports, and a physical examination, with office-based endoscopy studies and imaging as indicated. Various management options have been described in the literature. We recommend an expectant approach for asymptomatic patients; For symptomatic vaginal exposure, we encourage removal of entire mesh arm(s) via an abdominal approach; however, many prefer to utilize a transvaginal or partial excisional approach first. Spondylodiscitis is managed with long-term antibiotics and often requires mesh removal. Prevention strategies include using a lightweight polypropylene mesh attached to well- vascularized vaginal walls, avoiding direct placement on any sutured vaginotomy or cystotomy. Delayed absorbable monofilament suture is non-inferior to permanent suture.
Conclusions:
Sacrocolpopexy mesh complications can be challenging to diagnose and manage. Symptomatic cases often require a proactive approach; listening to patients when they describe persistent symptoms with postoperative onset; a low threshold for further evaluation; and upfront discussion of management options.
Insights
Sacrocolpopexy mesh complications, though rare, require careful diagnosis and management. Prompt evaluation and proactive treatment are key for symptomatic cases to ensure optimal patient outcomes.
Area of Science:
- Urogynecology
- Surgical Innovation
- Patient Safety
Background:
- Sacrocolpopexy is a durable surgical option for pelvic organ prolapse.
- Mesh-related complications can deter patients from undergoing this procedure.
Purpose of the Study:
- To review the incidence, presentation, diagnosis, management, and prevention of sacrocolpopexy mesh complications.
- To provide recommendations based on expert experience for challenging cases.
Main Methods:
- Literature review focusing on long-term mesh complications and their management.
- Inclusion of intraoperative videos and images to illustrate findings.
- Recommendations derived from a high-volume surgical center's experience.
Main Results:
- Common complications include vaginal mesh exposure, bladder/bowel erosions, inflammatory conditions (spondylodiscitis), and pain.
- Diagnosis involves thorough history, physical examination, and imaging.
- Management varies from expectant observation to surgical mesh removal, with specific strategies for spondylodiscitis.
Conclusions:
- Sacrocolpopexy mesh complications present diagnostic and management challenges.
- A proactive approach, including listening to patient symptoms and early evaluation, is crucial for symptomatic cases.
- Open discussion of management options with patients is recommended.
