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Prolapse Recurrence After Sacrocolpopexy Mesh Removal: A Retrospective Cohort Study

More than 20% of the adult female population have symptomatic pelvic organ prolapse (POP) and other pelvic floor disorders. Currently, recommended surgical repair procedures for pelvic floor disorders include native tissue repair and mesh sacrocolpopexy. Although mesh repair has proven durability compared with native tissue repairs, it is associated with an inherently different complication profile; specific mesh complications include mesh exposure and pain. In a study of women undergoing open sacrocolpopexy, the risk of mesh exposure at 7 years has been reported to be as high as 10.5%. As a result of complications, some patients may require partial mesh excision or complete removal. A number of studies have reported an increase in prolapse recurrence rates after removal of mesh; however, the patient population in these studies was heterogeneous, including women with either sacrocolpopexy and transvaginal mesh products. Moreover, many of these women also underwent concomitant repeat prolapse repair at the time of mesh removal. No study has examined rates of prolapse recurrence after sacrocolpopexy mesh removals compared with matched controls. The primary aim of this retrospective cohort study was to compare the proportion of prolapse recurrence in women after sacrocolpopexy mesh removal with that of women who underwent sacrocolpopexy without subsequent mesh removal. The authors hypothesized that mesh removal would increase the risk of POP recurrence. Sacrocolpopexy with subsequent mesh removal was performed in eligible women between January 2010 and January 2019 at a single institution. Patients in both groups were time matched by month and year of their index sacrocolpopexy. Recurrent vaginal prolapse was defined as the leading edge past the hymen on Pelvic Organ Prolapse-Quantification (POP-Q) examination at the time of mesh excision. Women were excluded who underwent mesh removal with a concomitant prolapse repair. All patients underwent hysterectomy before or at the time of index sacrocolpopexy. AWilcoxon rank-sum, χ, or t test with a Cox proportional hazards model was used to assess the association between mesh removal and time to recurrence. A total of 26 patients with mesh removal were matched with 78 patients without mesh removal. Exposure (69.2%) and pain (57.7%) were the most common indications for mesh removal. There was no significant difference between groups in route of index surgery. Women with mesh removal surgery were more likely to have an index procedure withMersilene mesh (19.2% vs 3.8%, P = 0.006). The incidence of prolapse recurrence was significantly higher in women who had mesh removal compared with thosewho did not (46.2% vs 7.7%,P < 0.001). After adjustment for potential covariables (age, parity, menopause, smoking, and diabetes status), women who had mesh removal had a 15 times higher likelihood of prolapse recurrence compared with those who did not have mesh removal (adjusted hazards ratio, 15.4; 95% confidence interval, 4.3–54.8; P < 0.0001). Women in this population who underwent sacrocolpopexy mesh removal were significantly more likely to have POP recurrence compared with time-matched controls. Future prospective studies are needed to determine the utility of concomitant prolapse repair at the time of mesh excision. Another avenue for future research is to determine why only some women experience a recurrence of prolapse.