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Risk factors for mesh complications after trocar guided transvaginal mesh kit repair of anterior vaginal wall prolapse§

Authors

  • Caroline Elmér,

    Corresponding author
    1. Division of Surgery and Urology, Department of Clinical Sciences, Karolinska Institutet Danderyd Hospital, Stockholm, Sweden
    • Department of Surgery and Urology, Danderyd University Hospital, 182 88 Stockholm, Sweden.
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  • Christian Falconer,

    1. Division of Obstetrics and Gynecology, Department of Clinical Sciences, Karolinska Institutet Danderyd Hospital, Stockholm, Sweden
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  • Anders Hallin,

    1. Division of Surgery and Urology, Department of Clinical Sciences, Karolinska Institutet Danderyd Hospital, Stockholm, Sweden
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  • Gregor Larsson,

    1. Department of Obstetrics and Gynecology, Västerås Hospital, Västerås, Sweden
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  • Marion Ek,

    1. Department of Obstetrics and Gynecology, South Hospital, Stockholm, Sweden
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  • Daniel Altman,

    1. Division of Obstetrics and Gynecology, Department of Clinical Sciences, Karolinska Institutet Danderyd Hospital, Stockholm, Sweden
    2. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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  • for the Nordic Transvaginal Mesh Group


  • Dirk De Ridder led the peer-review process as the Associate Editor responsible for the paper.

  • Conflict of interests: D.A. is an advisor to Gynecare Scandinavia and Ethicon US. C.F. is an advisor to Gynecare Scandinavia. None of the researchers in the Nordic transvaginal mesh group own stock or hold stock options in the mesh kit manufacturing company.

  • §

    Clinical trial registration: www.clinicaltrials.gov identifiers NCT00402844 and NCT00566917

Abstract

Aims

To identify risk factors for mesh exposures after anterior pelvic organ prolapse repair using a standardized trocar guided polypropylene mesh kit.

Methods

A secondary risk analysis combining patients from two prospective multicenter studies. Main outcome was clinical host-vs-implant reactions one year after surgery using a macroscopic inflammatory scale.

Results

353 patients were included in the study. Mean age at surgery was 65.3 (±9.6 SD) years and surgery was performed as a primary procedure in 224/353 (63.5%) patients. Mesh exposures, of which the majority were mild-moderate, occurred in a total of 30/349 patients (8.6%). Multivariate logistic regression showed increased odds for mesh exposures for women who smoked before surgery (OR 3.48, 95% CI 1.18–10.28), who had given birth to more than two children (OR 2.64, 95% CI 1.07–6.51) and those with somatic inflammatory disease (OR 5.11, 95% CI 1.17–22.23). Age, body mass index, and menopausal status showed no significant association with clinical mesh exposures.

Conclusions

Smoking, multiple childbirth, and somatic inflammatory disease are possible risk factors for mesh exposure after trocar guided mesh kit surgery for anterior pelvic organ prolapse. Preoperative smoking cessation may decrease the risk for exposures. Neurourol. Urodynam. 31:1165–1169, 2012. © 2012 Wiley Periodicals, Inc.

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