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)

METHODS:

• 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

RESULTS:

• 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

CONCLUSION:

• 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

Learn More – Primary Sources:

Long-term Rate of Mesh Sling Removal Following Midurethral Mesh Sling Insertion Among Women With Stress Urinary Incontinence

Related ObG Topics:

Surgery for Urinary Incontinence – When the Sling’s the Thing

Urinary Incontinence – How to Make the Diagnosis in Your Office and When to Refer

Prolapse and Stress Incontinence: Burch Procedure vs Midurethral Sling