Dylan T Wolff, Danielle Antosh, Maria J D'Amico, Fernanda Santis-Moya, Alexander Koven, Iryna Schmeil, Javier Pizarro-Berdichevsky, Jan Deprest, Amy Sisson, Howard B Goldman, Jacqueline Zillioux, Reut Rotem
Management of mesh-related complications following uterovaginal prolapse repair varies according to the location, severity, and extent of disease. Although the available evidence is limited, this review provides pragmatic management principles and treatment algorithms to support clinical decision-making in uncommon but potentially morbid complications.
INTRODUCTION AND HYPOTHESIS: Mesh-based repairs for uterovaginal prolapse are associated with rare and potentially severe complications for which evidence-based management guidance remains limited. Our goal was to perform a systematic review of the literature and develop pragmatic management principles for mesh-related complications following uterovaginal prolapse repair.
METHODS: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched MEDLINE and EMBASE through 11/11/25 for studies describing management of severe mesh-related complications following surgical repair of uterovaginal prolapse. Data collected included management strategies and clinical outcomes. Expert opinion and a modified Delphi process were used to develop consensus-based management algorithms and best practice statements.
RESULTS: Of the 8890 abstracts screened, 56 studies met the inclusion criteria. The majority were small retrospective case series with overall low quality evidence. Vaginal mesh exposure was the most commonly reported complication, and management ranged from conservative to mesh excision. Mesh exposure involving visceral organs or fistula formation was associated with substantial morbidity, often presenting years after surgery, and frequently required multidisciplinary surgical management with mesh excision and repair of involved organs. Post-sacrocolpopexy lumbosacral discitis most commonly presented with lower back pain and elevated inflammatory markers. Selected patients were successfully managed with prolonged antibiotics alone, while most cases ultimately underwent surgical mesh excision.
CONCLUSIONS: Management of mesh-related complications following uterovaginal prolapse repair varies according to the location, severity, and extent of disease. Although the available evidence is limited, this review provides pragmatic management principles and treatment algorithms to support clinical decision-making in uncommon but potentially morbid complications.