Vaginal Mesh Survivorship

Purpose of Review: Current care for women who have experienced complications related to vaginal mesh is complex and fragmented. In cancer, survivors are those who continue to function during and after overcoming their cancer diagnosis. “Survivorship” encompasses issues related to the ability to access health care and follow-up treatment, late effects of treatment, second cancers, and quality of life. The multifaceted survivorship model creates a sense of community among patients and their health care providers. Key aspects of survivorship, relevant to vaginal mesh complications, include (1) surveillance and follow-up treatment, (2) late effects of treatment, (3) health promotion and disease prevention, (4) psychosocial well-being, (5) caregiver needs, and (6) communication and care coordination. The objective is to propose the concept of vaginal mesh survivorship, examine which aspects of the cancer survivorship framework are applicable to patients with vaginal mesh complications, and apply these accordingly. Recent findings: A literature review of vaginal mesh complications was performed to identify the current state of care received by patients and patient-reported outcomes. Subcategories from the cancer survivorship framework were compared with the current care of women with vaginal mesh complications. Areas of improvement and gaps in research were identified. Summary: Nearly all domains of the cancer survivorship framework are pertinent to women with vaginal mesh complications. The surveillance for secondary cancers is not relevant, but there is a need for follow-up care as many women report subsequent health problems. There are late effects of treatment, such as pain and pelvic floor dysfunction, in a significant proportion of women. The need for health promotion, addressing psychosocial well-being, caregiver needs, and coordination of care is also relevant. Literature on the above topics is limited, and patient-centered research is important. Psychosocial support is critical as it has been shown that depression rates are higher in women who undergo subsequent surgery related to transvaginal mesh complications. The cancer survivorship framework allows us to assess gaps in care for women with mesh-related complications. Optimal methods on how to assess and care for these patients in a holistic manner do not routinely exist and should be developed in a multidisciplinary collaborative effort that includes patient input.