To examine long-term risks and predictors of mesh erosion and reoperation following midurethral sling (MUS) procedure for stress urinary incontinence (SUI).
Women aged 18 years or older who received a MUS procedure for SUI between 2008 and 2016 in outpatient surgical settings in New York State were included in our study. Those who underwent concomitant mesh pelvic organ prolapse repair were excluded. Primary outcomes were post-implantation time to erosion and reoperations. Kaplan-Meier analysis and Cox proportional hazard models were used to assess the risks of erosion diagnosis and reoperation.
Our cohort included 36,195 women with a mean age of 53.7 + 12.4 (SD) years. Estimated risks of erosions and reoperations at 7 years after sling procedures were 3.7% and 6.7%, respectively. Older age (≥65 vs. <65: HR 0.83, 95% CI 0.70-0.99) and high-volume facilities (high vs. low: HR 0.79, 95% CI 0.68-0.92) were associated with a lower risk of erosion. History of hysterectomy was associated with a higher risk of erosion (HR 1.62, 95% CI 1.36-1.92). Predictors of reoperation included concurrent abdominal or native-tissue transvaginal prolapse repair, previous hysterectomy, and depression.
One in 27 women had sling erosions and one in 15 had invasive reoperations at 7 years after sling procedures. The highest erosion cases were observed among younger white women treated at low-volume facilities. Continued and vigilant surveillance of mesh in SUI repairs, the nature and burden of SUI recurrence, different types of re-treatment, patient-reported outcomes, and information about treating surgeons are crucial.
The Journal of urology. 2020 Aug 04 [Epub ahead of print]
Bilal Chughtai, Jialin Mao, Michael E Matheny, Elizabeth Mauer, Samprit Banerjee, Art Sedrakyan
Department of Urology, Weill Cornell Medical College-New York Presbyterian, New York, New York., Department of Healthcare Policy and Research, Weill Cornell Medical College-New York Presbyterian, New York, New York., Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee.