Vaginal mesh erosion after abdominal sacral colpopexy

OBJECTIVE: Our goal was to compare the prevalence of vaginal mesh erosion b etween abdominal sacral colpopexy and various sacral colpoperineopexy proce dures. STUDY DESIGN: We undertook a retrospective analysis of all sacral colpopexi es and colpoperineopexies performed between March 1, 1992, and February 28, 1999. The patients were divided into the following 4 groups: abdominal sac ral colpopexy, abdominal sacral colpoperineopexy, and 2 combined vaginal an d abdominal colpoperineopexy groups, one with vaginal suture passage and th e other with vaginal mesh placement. Survival analysis and Cox proportional hazards models were developed to examine erosion rates and time to erosion between groups. RESULTS: A total of 273 abdominal sacral vault suspensions were performed w ith the use of permanent synthetic mesh. There were 155 abdominal sacral co lpopexies and 88 abdominal sacral colpoperineopexies. Among the 30 combined abdominal-vaginal procedures, 25 had sutures attached to the perineal body and brought into the abdominal field and 5 had mesh placed vaginally and b rought into the abdominal field. Overall, mesh erosion was observed in 5.5% (15/273). The prevalence of mesh erosion was 3.2% (5/155) in the abdominal sacral colpopexy group and 4.5% (5/88) in the abdominal sacral colpoperine opexy group (P not significant). The rates of erosion when sutures or mesh was placed vaginally were 16% (4/25) and 40% (2/5), respectively, and were significantly increased in comparison with the rates for abdominal sacral c olpopexy (hazard ratio, 5.4; 95% confidence interval, 1.6-18.0; P=.005; vs hazard ratio, 19.7; 95% confidence interval, 3.8-101.5; P<.001). These vari ables retained their significance after we controlled for other independent variables, including age, concomitant hysterectomy, concomitant posterior repair, and estrogen status. The median time to mesh erosion was 15.6 month s for abdominal sacral colpopexy, 12.4 months for abdominal sacral colpoper ineopexy, 9.0 months in the suture-only group (P <.005), and 4.1 months in the vaginal mesh group (P<.0001). CONCLUSIONS: The rate of mesh erosion is higher and the time to mesh erosio n is shorter with combined vaginal-abdominal sacral colpoperineopexy with v aginal suture and vaginal mesh placement in comparison with abdominal sacra l colpopexy.