**9. Outcomes and complications of using self-fashioned mesh**

Our results for using self-fashioned mesh for the treatment of concurrent stress urinary incontinence and pelvic organ prolapse showed a relatively high success rate in curing urinary incontinence (continence was 80%, improvement was 17%) and less recurrence of anterior vaginal wall prolapse (none with recurrent prolapse greater than stage II) in a threeyear follow-up. However, mesh erosion was not completely averted. Exposed vaginal mesh was removed uneventfully. None of these patients experienced recurrent urinary incontinence and prolapse.

#### **9.1 Comparison of relevant published articles**

There are three similar articles using self-fashioned mesh for treating stress urinary incontinence and anterior vaginal wall prolapse have been found in recent five years (Mustafa and Wadie, 2006; Amrute et al., 2007; Eboue et al., 2010 ). Character of mesh, patient number, mean follow-up period, success rates, and complications of these articles and ours are as tabled below (Table 1). Outcomes of using self-fashioned meshes are promising. Mesh erosion rates in these case series are acceptable compared to that of commercial mesh kits (Jelovsek et al. 2007; Gomelsky et al., 2011).

The rationale for using self-fashioned mesh is: (1) to support the proximal urethra, bladder neck and anterior vaginal wall so they are simultaneously free of tension; (2) to provide a frame for augmenting the vaginal wall; (3) to fashion the size of the mesh to fit the defect in the vaginal wall; (4) to avoid complications induced by mesh arms by not using additional fulllength mesh arms. A mesh patch lessens the amount of synthetic materials present in the wound bed which might diminish potential complications. Technically, it would be easier to remove the mesh patch than the full-length mesh if late complications occur (Tsui et al. 2005).

Suburethral Slingplasty Using a Self-Fashioned Mesh

**9.2 Comparative cost of a self-fashioned mesh** 

because of the lower expense of a self-fashioned mesh kit.

treating this disease.

**10. Conclusion** 

**11. References** 

anterior vaginal wall simultaneously.

pp. 195-201, ISSN 0147-1988

1018, ISSN 0029-7844

for Treating Urinary Incontinence and Anterior Vaginal Wall Prolapse 229

The price of commercial mesh kits varies in the international market. In Taiwan, the National Health Insurance (NHI) covers some commercial kits for patients undergoing antiincontinence surgery. The commercial mesh kits for pelvic organ prolapse are not covered by NHI. Patients choosing commercial mesh kits for treating their pelvic organ prolapse must pay 1,200-2,000 USD out of their own pockets for the additional surgical cost. In comparison, the cost of a self-fashioned mesh is relatively affordable for patients with stress urinary incontinence and pelvic organ prolapse, and the success rate is not compromised

Stress urinary incontinence and pelvic organ prolapse are significant problems in relatively affluent countries. However, early childbearing and high fertility with early marriage, many vaginal deliveries, and frequent heavy lifting result in a high prevalence of stress urinary incontinence and pelvic organ prolapse. The situation in developing countries is far worse and cannot be overlooked (Wunasekera et al., 2007). Therefore, financial consideration for choosing a self-fashioned mesh or commercial mesh kits seems to be an important issue for

This procedure provides an easier placement technique, a relatively high success rate, and less recurrence. The complications of the self-fashioned mesh (monofilament and macroporous polypropylene) are acceptable compared to other commercial mesh kits. In addition, the cost of the self-fashioned mesh is cheaper than the commercial mesh kits. The self-fashioned mesh is an alternative option for treating stress urinary incontinence and

Amrute, KV.; Eisenberg, ER. Rastinehad, AR. Kushner, L. & Badlani, GH. (2007). Analysis of

Baessler, K. & Maher, CF. (2006). Mesh augmentation during pelvic floor reconstructive

Bai, SW.; Jeon, MJ. Kim, JY. Chung, KA. Kim, SK. & Park, KH.. (2002). Relationship between

Beck, RP.; McCormick, S.& Nordstrom, L.(1991). A 25-year experience with 519 anterior

Boreham, MK.; Wai, CY. Miller, RT. Schaffer, JI. & Word, RA. (2002). Morphometeric

Borstad, E. & Rud, T. (1989). The risk of developing urinary stress incontinence after vaginal

*Gynecol Scand Suppl,* Vol. 68, No.6, pp. 545-549, ISSN 0001-6349

Neurourol Urodyn, Vol. 26, No.1, pp. 53-58, ISSN 0733-2467

*Dysfunct,* Vol.13, No.4, pp. 256-260, ISSN 0937-3462

Outcomes of Single Polypropylene Mesh in Total Pelvic Floor Reconstruction

surgery: risks and benefits. *Curr Opin Obstet Gynecol,* Vol.18, No.5, (October 2006),

stress urinary incontinence and pelvic organ prolapse. *Int Urogynecol J Pelvic Floor* 

colporrhaphy procedures. *Obstet Gynecol,* Vol. 78, No.6, (December 1991), pp. 1011-

analysis of smooth muscle in the anterior vaginal wall of women with pelvic organ prolapse. *Am J Obstet Gynecol,* Vol. 187, No. 1, (July 2002), pp.56-63, ISSN 0002-9378

repair in continent women. A clinical and urodynamic follow-up study. *Acta Obstet* 


Table 1. Clinical information self-customized mesh studies

#### **9.2 Comparative cost of a self-fashioned mesh**

The price of commercial mesh kits varies in the international market. In Taiwan, the National Health Insurance (NHI) covers some commercial kits for patients undergoing antiincontinence surgery. The commercial mesh kits for pelvic organ prolapse are not covered by NHI. Patients choosing commercial mesh kits for treating their pelvic organ prolapse must pay 1,200-2,000 USD out of their own pockets for the additional surgical cost. In comparison, the cost of a self-fashioned mesh is relatively affordable for patients with stress urinary incontinence and pelvic organ prolapse, and the success rate is not compromised because of the lower expense of a self-fashioned mesh kit.

Stress urinary incontinence and pelvic organ prolapse are significant problems in relatively affluent countries. However, early childbearing and high fertility with early marriage, many vaginal deliveries, and frequent heavy lifting result in a high prevalence of stress urinary incontinence and pelvic organ prolapse. The situation in developing countries is far worse and cannot be overlooked (Wunasekera et al., 2007). Therefore, financial consideration for choosing a self-fashioned mesh or commercial mesh kits seems to be an important issue for treating this disease.
