Risk factors and outcomes of vaginal mesh erosions after pelvic reconstructive surgery: A retrospective cohort study

Mesh erosions can occur in pelvic reconstructive surgeries for pelvic organ prolapse and stress urinary incontinence. The purpose of this study was to investigate the risk factors and outcomes of mesh erosion after surgical procedures using synthetic mesh. Pelvic reconstructive surgeries performed at a tertiary center during the 5 years between January 2019 and January 2024 were retrospectively analyzed. Patients were classified into the mesh erosion group and the non-erosion group. Clinical features and outcomes were compared. The study included 510 patients, 49 in the mesh erosion group and 461 in the non-erosion group. The incidence of mesh erosion was 9.6%. There was no significant difference between the groups in terms of age, parity, menopausal status, pelvic organ prolapse stage, and concomitant hysterectomy (P = .243, P = .066, P = .349, P = .374, and P = .119, respectively). In the mesh erosion group, body mass index (27.1 ± 3.3 vs 25.9 ± 3.6, P = .016), smoking (28.6% vs 14.3%), sexual activity (77.6% vs 61.8%), vaginal incision size (3.5 ± 1.7 vs 2.3 ± 0.8, P = .001) and hypertension (22.4% vs 13%, P = .070) were significantly higher. Vaginal incision size (>2.5 cm) and sexual activity were found to be independent risk factors for mesh erosion. In patients with mesh erosion, 18.3% (n = 9) received conservative treatment, and 81.7% (n = 40) received surgical treatment. In patients who underwent surgical treatment, mesh erosion size (>0.5 cm) and body mass index were significantly higher (P = .015 and P < .001, respectively). Erosion recurrence was detected in 16.3% (n = 8) of patients in the mesh erosion group. Although mesh erosions do not occur frequently in pelvic reconstructive surgeries, they are complications that can disrupt patient comfort. Vaginal incision size and sexual activity were determined as independent risk factors for mesh erosions. When mesh erosion is detected, conservative treatment may benefit small erosions. The surgical approach should be performed in patients with severe symptoms and extensive erosions.