Authors: Ahmed AlBadr
Publish Date: 2011/05/05
Volume: 22, Issue: 7, Pages: 897-
Abstract
I read with interest the document “An International Urogynecological Association IUGA / International Continence Society ICS joint terminology and classification of the complications related directly to the insertion of prostheses meshes implants tapes and grafts in female pelvic floor surgery” published in your respected journal 1 and in Neurourology and Urodynamics 2 I find it useful in standardizing terminology for the reporting of complications related to grafts and prosthesesI wanted to highlight an issue that is encapsulated nicely by the example of patient 333 in Table 4 of the article with mesh fiber exposure reported as 1B According to definitions stated in the same document category 1 should be for “Vaginal complication—no epithelial separation This incorporates the terms prominence eg due to wrinkling or folding or contraction shrinkage Also incorporated here is the palpation of mesh fibres” If fibers are protruding though the epithelium then there must be some separation of epithelium moreover is this limited by only one threadI think if mesh fiber is felt under the epithelium without it being seen in the vagina then this qualifies for 1A If there is any discontinuation of epithelium however even by one fiber this should be reported as 2B as the management is different In the case of palpation of fibers under the epithelium without protrusion through the epithelium then the classification should be 2B rather than 1B
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