The developing field of meshology - what is new in the management of mesh complications in female incontinence and prolapse - a systematic review of outcomes.

Abstract

Women having mesh procedures may require revision surgery in the long term due to complications. In the past decade, the field has evolved, moving towards specialist mesh centres. This systematic review analyses indications for treatment, whether complete mesh removal was achieved and treatment outcomes for delayed mesh complications. Fifty-six studies involving 4480 patients were identified from 2015 to 2025, to our knowledge, making this the largest systematic review of mesh complications in the modern era. Pain is the most common reason for seeking treatment for mesh complications and is present in up to 49-68% of women. Isolated surgical treatment for pain in the absence of anatomical abnormalities has poorer outcomes and often requires a holistic approach with specialist pain input. Asymptomatic vaginal exposure of under 1 cm can be treated with topical oestrogen with excellent success rates in selected patients. Endoscopic treatment for urethral extrusion has a 3% risk of urethrovaginal fistula. The risk of de novo incontinence is higher when the sub-urethral component of the mesh is removed compared to mesh arms (odds ratio 10.7). In large series, 15.6% of patients stayed in hospital for over 2 days after mesh removal, with a 2.8-13.7% incidence of >Clavien 3 complications. Robotic mesh removal surgery is an emerging approach and may play an important role, particularly when additional procedures are required, such as ureteric reconstruction and colposuspension.