Choosing Wisely:

Don’t perform surgery for asymptomatic vaginal exposure of monofilament mesh.

Rationale and Comments: Vaginal exposure of mesh used in surgery for the treatment of pelvic organ prolapse or urinary incontinence is a known complication of such surgeries. Although symptomatic exposure may require treatment, evidence suggests that asymptomatic mesh exposure can be safely watched without surgery to avoid the risks and complications associated with surgery for mesh exposure. Longitudinal expectant management is a reasonable alternative.
Sponsoring Organizations:
  • American Urogynecologic Society
  • Sources:
  • ACOG guidelines
  • Disciplines:
  • Gynecologic
  • Surgical
  • References: • American College of Obstetricians and Gynecologists. Committee opinion no. 694: management of mesh and graft complications in gynecologic surgery. Obstet Gynecol. 2017;129(4):e102-e108.
    • Deffieux X, Thubert T, de Tayrac R, Fernandez H, Letouzey V. Long-term follow-up of persistent vaginal polypropylene mesh exposure for transvaginally placed mesh procedures. Int Urogynecol J. 2012;23(10):1387-1390.
    • Kobashi KC, Govier FC. Management of vaginal erosion of polypropylene mesh slings. J Urol. 2003;169(6):2242-2243.

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