Radiological Characterization of Synthetic Mesh in Female Urological Procedures: a Review of the Literature

Purpose of Review: Surgical mesh is now commonplace among many urogynecologic procedures. Post-surgical imaging of mesh is useful when complications including mesh erosion, bleeding, and chronic pain arise. Different types of mesh coated with various materials have been developed to improve visibility on imaging studies. However, localization of surgical mesh after implantation remains challenging as visualization with standard imaging is difficult. The purpose of this study was to review the various radiologic approaches to characterizing synthetic surgical meshes. Recent Findings: A systematic and comprehensive literature search was performed by two independent reviewers using the PubMed database of the National Library of Medicine to identify all potentially relevant publications published before April 2020. Studies assessing the use of imaging for surgical mesh in both urogynecologic and non-urogyneocologic procedures were included. Iron impregnated mesh was most visible on imaging such as magnetic resonance imaging (MRI) and computed tomography (CT). Impregnated mesh was also shown to be more readily visible on ultrasound when compared to its non-iron containing counterpart. Non-impregnated expanded polytetrafluorethylene mesh (EPTF Mesh) was visible on CT and MRI. The more commonly used polypropylene and polyvinylidene mesh were more readily visualized on ultrasound although localization of surrounding structures remains difficult. Summary: Imaging surgical mesh poses an ongoing problem when complications arise. Although particle impregnated mesh is visible on CT and MRI, the adoption of this practice is still in its infancy. The ability to visualize EPTF mesh on CT and MRI is a promising advancement, but proper visualization of the more common synthetic meshes remains a limitation.