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World J Obstet Gynecol. Feb 10, 2016; 5(1): 73-77
Published online Feb 10, 2016. doi: 10.5317/wjog.v5.i1.73
Role of ultrasound imaging in advancing treatment of female patients with pelvic floor mesh complications
William Singh, Harpreet Wadhwa, Whitney Halgrimson, Ervin Kocjancic
William Singh, College of Medicine at University of Illinois at Chicago, Chicago, IL 60612, United States
Harpreet Wadhwa, Whitney Halgrimson, Ervin Kocjancic, Department of Urology at University of Illinois at Chicago, Chicago, IL 60612, United States
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Conflict-of-interest statement: The authors declare no conflicts of interest regarding this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Ervin Kocjancic, MD, Department of Urology, University of Illinois at Chicago, 515 CSN - 820 South Wood Street, M/C 955, Chicago, IL 60612, United States. ervkoc@gmail.com
Telephone: +1-312-9969330
Received: September 3, 2015
Peer-review started: September 8, 2015
First decision: September 29, 2015
Revised: October 14, 2015
Accepted: December 9, 2015
Article in press: December 11, 2015
Published online: February 10, 2016
Processing time: 150 Days and 9.4 Hours
Abstract

Application of vaginal mesh for stress urinary incontinence has seen widespread use due to its relatively short operative time in combination with its efficacy in treatment. However, vaginal mesh is not without its drawbacks and can lead to mesh erosion or extrusion, infection, dyspareunia, and recurrence of incontinence. Vaginal mesh complications can lead to feelings of hopelessness, isolation, shame, and emotional distress. Furthermore, failure to identify and address these complications in a timely manner can be permanently damaging to patient health. It is vital to be able to identify mesh complications early. Various imaging methodologies exist to visualize vaginal mesh placement and complications, including ultrasound, magnetic resonance imaging (MRI), and computed tomography (CT). This invited review paper focuses on the role of ultrasound in mesh visualization, mesh complication identification, and operative planning in the event of subsequent surgical mesh revision. Polypropylene mesh is echogenic on ultrasound, making it a useful tool for visualizing post-operative mesh placement. Transperineal, translabial and endovaginal ultrasound technique use has been described in the pre- and peri-operative setting to identify mesh in complex cases. Efficacy and practicality of CT and MRI use in identifying mesh in these cases is limited.

Keywords: Mesh complications; Imaging; Ultrasound; Computed tomography; Magnetic resonance imaging; Mesh revision; Stress urinary incontinence; Erosion; Extrusion; Dyspareunia

Core tip: Pelvic ultrasound is a valuable and inexpensive technique that can be used both for localization, diagnosis, preoperative planning, and intraoperative guidance when dealing with mesh complications.