#Grand Rounds

How Common is Midurethral Mesh Slings Replacement at 9 years Out?

BACKGROUND AND PURPOSE:

Gurol-Urganci et al. (JAMA, 2018) sought to determine mesh removal and reoperation rates for midurethral mesh sling insertion in women with stress urinary incontinence (SUI)

Population-based retrospective cohort study
- Women ≥18 years
- Midurethral mesh sling insertion (first) for SUI
Received either
- Retropubic mesh sling insertions
- Transobturator mesh sling insertions
Primary outcome
- Risk of midurethral mesh sling removal (partial or total)
Secondary outcomes
- Reoperation for SUI
- Any reoperation that included mesh removal

95,057 patients
- Retropubic: 60,194 were
- Transobturator: 34,863
Median age: 51 years (interquartile range, 44-61 years)
Median follow-up time: 5.5 years (interquartile range, 3.2-7.5 years)
Rate of midurethral mesh sling removal
- 1 year: 1.4% (95% CI, 1.3%-1.4%)
- 5 years: 2.7% (95% CI, 2.6%-2.8%)
- 9 years: 3.3% (95% CI, 3.2%-3.4%)
Removal risk higher with retropubic vs transobturator insertion (9 year)
- Transobturator insertion: 2.7% (95% CI, 2.4%-2.9%)
- Retropubic insertion: 3.6% (95% CI, 3.5%-3.8%)
- Hazard ratio, 0.72 (95% CI, 0.62-0.84)
Rate of reoperation for stress urinary incontinence
- 1 year: 1.3% (95% CI, 1.3%-1.4%)
- 5 years: 3.5% (95% CI, 3.4%-3.6%)
- 9 years: 4.5% (95% CI, 4.3%-4.7%)
The rate of any reoperation including mesh removal
1 year: 2.6% (95% CI, 2.5%-2.7%)
5 years: 5.5% (95% CI, 5.4%-5.7%)
9 years: 6.9% (95% CI, 6.7%-7.1%)
Risks of removal and any reoperation (mesh removal and/or reoperation for SUI) were higher for
- Younger age groups
- White racial/ethnic background
- Did not appear to be associated with socioeconomic deprivation

Use of sling has decreased substantially due to concerns regarding complications
The authors suggest that the data from this large cohort study may be helpful when discussing treatment options for SUI

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