65 women with either vaginal implants, abdominal mesh or both presented with suspected complications and were investigated with an MRI during this time period. 47 patients had only 1 mesh implant in situ, 12 patients had 2 separate mesh implants and 6 had 3 separate mesh implants in place.
26 women had transobturator tapes (TOT) implants in situ, 8 had a Retropubic-tape (RP-Tape) mesh implants in situ, 20 had trans-vaginal mesh (TVM) implants for POP and 23 had abdominal mesh for POP (sacrocolpopexy / rectopexy).
Women had more than one presenting complaint. 45 women presented with pain, 11 with vaginal mesh exposure, 5 with urinary symptoms, 1 with bowel symptoms, 6 with vaginal discharge, 7 with dyspareunia. 3 women also had concurrent POP However, 3 women presented with a recurrent POP following a sacrocolpopexy as their only symptom.
Looking at the separate implant types, MRI was able to detect:
o Abdominal meshes in 91.3% (21/23) of women,
o Retropubic tape in 75% (6/8) of women,
o TOT mesh in 42.3% (11/26) of women,
o TVM in 50 % (10/20) of women.
Overall, MRI picked up pathology, both mesh-related and not, in 23.1% (15/65) of women. MRI detected no positive radiological findings in 50 women.
4/15 patients in whom the initial complaint was of pelvic pain had an MRI which showed no mesh related complications, but which revealed other pathology which could explain their pain. 2 of them were subsequently referred to Orthopaedics for further investigation of degenerative hip changes, 1 to Neurology for investigation of spinal abnormalities and 1 to General Surgery for investigation of proctitis.
In the 11/15 women in whom a mesh-associated complication was detected, the mesh itself was identified on MRI in 7 of them, was partially seen in 3 and was not identified in 1 of them. The positive findings are described below:
o In the 5 women with mesh-associated infection (Table 1), MRI showed more extensive pelvic infection than the initial clinical findings suggested (example Picture 1) and helped inform surgical management and patient counselling. All 5 women underwent surgery and MRI were confirmed at time of surgery. Of these 5 women, MRI also identified the concurrent vaginal mesh exposure in 1 patient,
o 1 woman had mesh exposure in the bladder with concomitant vaginal exposure and 1 woman had urethral exposure on MRI. Cystoscopy and subsequent surgery confirmed the findings.
o With abdominal meshes, 2 women had mesh rupture on MRI. MRI findings were confirmed on surgery in one woman and the other 1 is awaiting surgery.
o 1 woman, who presented with groin pain, was found to have inflammation linked to the right arm of her TOT implant on MRI. She is awaiting surgery for tape removal.
o Overall, MRI identified vaginal mesh exposure in 18.8% (3/16) of patient with clinically confirmed vaginal mesh exposure. 1 woman had vaginal mesh exposure alone on MRI and 2 had concomitant MRI findings, (1 with pelvic infection, other with bladder mesh exposure, as described above).