Does Mesh-Based Stress Urinary Incontinence Surgery Increase the Risk for Pelvic Malignancies?
BACKGROUND AND PURPOSE:
Surgery for stress urinary incontinence (SUI) is common, and can involve mesh or non-mesh procedures
There has been public concern about the safety of mesh used for SUI and pelvic organ prolapse (POP) surgeries due to animal studies and rare case reports
This effect in not necessarily translatable to humans
Vigil et al. (Journal of Urology, 2021) examined whether SUI surgery (mesh or non-mesh) is associated with the development of pelvic malignancies later in life
Retrospective cohort study
All women in Ontario, Canada
No history of pelvic malignancy
Underwent an index SUI surgery
Control cohort: No SUI surgery
No urinary incontinence surgery
Survival analysis using a Cox proportional-hazards model
Patients were followed until death, emigration or the study end (October, 2017)
Multivariable adjustments made to account for: Age | Demographics | Comorbidity
A composite of any pelvic malignancy (including urological and gynecological cancers) following SUI surgery
Urological and gynecological cancers individually
74,968 women who underwent SUI surgery | 5,505,576 in the control cohort
Incidence of pelvic malignancies
SUI surgery: 587 malignancies over a median (IQR) follow-up 8.5 years (5.5 to 11.9)
Compared to controls, women who underwent SUI surgery had a reduced risk of pelvic malignancy independent of surgery type (p < 0.001)
Mesh: Hazard ratio (HR) 0.68 (95% CI, 0.62 to 0.76); p < 0.0001
Non-mesh: HR 0.37 (95% CI, 0.29 to 0.46); p < 0.0001
Individual pelvic cancers showed a similarly reduced risk following SUI surgery
In this large population-based cohort with a median follow-up of 8.5 years, women who underwent SUI surgery, with and without mesh, did not have increased rates of pelvic malignancies
Reduced malignancy risk in the surgery group is likely due to selection bias, although a true reduction can not be ruled out
Patients undergoing a quality of life directed procedure may be in better health from the outset
An otherwise asymptomatic pelvic malignancy could be detected during the SUI procedure and treated early
The authors state
Present day polypropylene mesh has a microporous and monofilament makeup; therefore, the conclusions of early animal studies cannot be extrapolated to humans as it relates to modern day polypropylene mesh use
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This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
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presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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