Vaginal Mesh Revision Surgery: A Focus on Functional Outcomes

Abstract

Background/Objectives: Mesh-related complications after surgery for stress urinary incontinence (SUI) and pelvic organ prolapse (POP) remain a clinical challenge, and surgical revision is often required. However, its impact on functional outcomes and continence status is incompletely defined. This study aimed to evaluate voiding and continence outcomes after surgical revision of vaginal synthetic mesh. Methods: This retrospective multicenter study included 55 consecutive women undergoing surgical revision of synthetic mesh for symptomatic complications after SUI or POP procedures between March 2021 and April 2025. Preoperative evaluation included clinical assessment, uroflowmetry, and selective imaging or urodynamic studies. Surgical management included mesh section, partial removal, or total removal via vaginal, abdominal, or combined approaches. The primary outcome was change in Qmax and post-void residual (PVR). Secondary outcomes included symptom resolution, changes in urgency urinary incontinence (UUI) and SUI, and postoperative complications. Results: Obstructive voiding dysfunction was the leading indication for revision (47.3%). Median Qmax increased from 13.0 to 18.0 mL/s (p = 0.0013), and median PVR decreased from 55.0 to 5.0 mL (p < 0.001). UUI improved from 56.4% to 34.5% (p = 0.017, McNemar’s exact test). Conversely, SUI increased from 20.0% to 56.4% (p < 0.001), although only 16 patients (29.1%) had clinically significant postoperative SUI, of whom 7 underwent a secondary anti-incontinence procedure. Intraoperative complications were infrequent (5.5%), while postoperative urinary tract infections occurred in 16.4%. Conclusions: Mesh revision surgery improves voiding function and reduces storage symptoms in selected patients but carries a substantial risk of recurrent or de novo SUI, underscoring the need for careful patient selection and counseling, with an acceptable safety profile in experienced centers.