1675 IMPACT OF TRANSLABIAL ULTRASOUND ON DIAGNOSIS AND TREATMENT OF MESH RELATED COMPLICATIONS

Abstract

Objectives: The prevalence of patients presenting with mesh related complications at our tertiary center is increasing. Symptom assessment, clinical examination and cystoscopy help to elucidate mesh complications, however, there are diagnostic limits. Surgical reports on patient s history of previous prolapse or incontinence repair utilizing mesh are of ten missing. The purpose of the study was to evaluate ultrasound (US) as a diagnostic method to locate the mesh, to evaluate underlying symptoms, and to guide the surgical approach of removal. Methods: Between 01/09 and 09/09 15 consecutive patients came to our tertiary referral center with mesh related complications. In a prospective observational study all patients were evaluated for clinical symptoms and findings on 2-D translabial US. Coronal, sagittal, and axial views were obtained with a curved transducer. Results: Mean age was 56.2 years (range 38-82). Out of 15 patients of the total patient population seven had undergone a periurethral sling procedure only, two a sling and concomitant anterior vaginal wall prolapse (AVW) repair, one an isolated posterior wall (PVW) repair, two a sling and concomitant AVW and PVW repair, one an isolated AVW repair, and two an AVW and concomitant PVW repair. Patients main complaints were dyspareunia (Figure presented) (n=10), LUTS (n=13), pelvic pain (n=10), recurrent UTI (n=4), recurrent SUI (n=5), vaginal fullness (n=4), and autoimmune reaction requiring immunosuppressive therapy (n=1). All patients underwent translabial US. Mesh dislocation, folding, shrinkage, or disruptions were seen in 12 patients (80%). Of10 patients, who had undergone a suburethral sling procedure, 8 patients presented sono- graphically with misplaced or folded mesh and 2 with a cystic lesion or foreign body granuloma periurethrally. All AVW patients (n=8) presented sonographically with mesh dislocation, folding, and shrinkages. A recurrent cystocele was found in 6 patients. Five patients underwent a posterior repair. Translabial US detected mesh dislocation on all patients and a recurrent rectocele in 4 patients. Conclusions: US is the only diagnostic method to evaluate mesh, to detect dislocation, folding, misplacement, or shrinkage. Translabial US can differentiate between symptoms related or unrelated to mesh complications. It is a useful cost-efficient and non-invasive tool to localize misplacement and to determine the best surgical approach for mesh removal.