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Grand Rounds

Does Mesh-Based Stress Urinary Incontinence Surgery Increase the Risk for Pelvic Malignancies?

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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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Related ObG Topics:

Cochrane Review: Best Treatment Options for Stress Urinary Incontinence
Surgery for Stress Urinary Incontinence: Which Procedures are Most Effective and Safest?
Results from the French VIGI-MESH registry: Short-Term Complications Following Pelvic Floor Surgery

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