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

METHODS:

• Retrospective cohort study
• Population
  • All women in Ontario, Canada
  • No history of pelvic malignancy
  • Underwent an index SUI surgery
  • Control cohort: No SUI surgery
• Exposures
  • Mesh surgery
  • Non-mesh surgery
  • No urinary incontinence surgery
• Study design
  • 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
• Primary outcome
  • A composite of any pelvic malignancy (including urological and gynecological cancers) following SUI surgery
• Secondary outcomes
  • Urological and gynecological cancers individually

RESULTS:

• 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

CONCLUSION:

• 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

Learn More – Primary Sources:

Stress Incontinence Surgery Does Not Cause Pelvic Malignancy: A Population-Based Cohort Study

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