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Ultrasound appearances after mesh implantation—evidence of mesh contraction or folding?

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Abstract

Introduction and hypothesis

Polypropylene meshes are frequently used in abdominal and vaginal reconstructive surgery. Recently, several authors have claimed that mesh-associated complications may be linked to mesh shrinkage. We have performed a prospective study with postoperative follow-up by ultrasound examination at two time points after Prolift anterior implantation to assess changes in the ultrasound appearance of mesh implants over time.

Methods

We assessed 36 patients who had undergone mesh implantation with Prolift anterior™ mesh for the correction of symptomatic anterior vaginal wall prolapse. During the surgery, we measured the actual midline length of the mesh (initial length). On the fourth postoperative day, we performed a vaginal ultrasound examination (US) to measure mesh length in the midsagittal plane. A second US was performed 3–5 months after surgery to repeat this measurement.

Results

There was a significant difference in mesh length determined before and 4 days after surgery (90.3 vs. 57.1 mm, P = <0.0001) indicating intraoperative folding. On comparing early and late postoperative ultrasound measurements, there was a reduction in length from 57.1 to 48.3 mm (P < 0.0001), indicating possible shrinkage or retraction.

Conclusions

Intraoperative folding seems to be responsible for a large part of the difference between preoperative (in vitro) and postoperative (US) measurements of mesh dimensions, suggesting that surgical techniques may require adjustment.

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Abbreviations

POP-Q:

Pelvic organ prolapse quantification system

US:

Ultrasound

ICC:

Intraclass correlation

CT:

Computer tomography

MR:

Magnetic resonance

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Acknowledgements

This work was supported by the Grant Agency of the Ministry of Health of the Czech Republic, grant NR/9216-3.

Conflicts of interest

A. Martan provides consultation for Gynecare, Bard, and AMS.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University in Prague and General University Hospital, Apolinarska 18, Prague 2, 128 00, Czech Republic

    Kamil Svabík, Alois Martan, Jaromir Masata, Rachid El-Haddad & Petr Hubka

  2. EuroMISE Centre, Institute of Computer Science of the Academy of Sciences of the Czech Republic, Prague, Czech Republic

    Marketa Pavlikova

Authors
  1. Kamil Svabík
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  2. Alois Martan
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  3. Jaromir Masata
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  4. Rachid El-Haddad
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  5. Petr Hubka
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  6. Marketa Pavlikova
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Correspondence to Kamil Svabík.

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Svabík, K., Martan, A., Masata, J. et al. Ultrasound appearances after mesh implantation—evidence of mesh contraction or folding?. Int Urogynecol J 22, 529–533 (2011). https://doi.org/10.1007/s00192-010-1308-9

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  • DOI: https://doi.org/10.1007/s00192-010-1308-9

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