Surgical Removal of Midurethral Sling in Women Undergoing Surgery for Presumed Mesh-Related Complications: A Systematic Review.

To assess whether some, or all, of the mesh needs to be removed when a midurethral sling is removed for complications.

A systematic review and meta-analysis was conducted. MEDLINE, Cochrane, and ClinicalTrials. gov databases from January 1, 1996, through May 1, 2021, were searched for articles that met the eligibility criteria with total, partial, or a combination of anti-incontinence mesh removal.

All study designs were included (N≥10), and a priori criteria were used for acceptance standards. Studies were extracted for demographics, operative outcomes, and adverse events. Meta-analysis was performed when possible.

We double-screened 11,887 abstracts; 45 eligible and unique studies were identified. Thirty-five were single-group studies that evaluated partial mesh removal, five were single-group studies that evaluated total mesh removal, and five were studies that compared partial mesh removal with total mesh removal. All of the studies were retrospective in nature; there were no randomized controlled studies. Comparative studies demonstrated that partial mesh removal had lower rates of postoperative stress urinary incontinence (SUI) than total mesh removal (odds ratio 0.46, 95% CI 0.22-0.96). Single-group studies supported lower rates of postoperative SUI with partial mesh removal compared with total mesh removal (19.2% [95% CI 13.5-25.7] vs 48.7% [95% CI 31.2-66.4]). Both methods were similar with respect to associated pain, bladder outlet obstruction, mesh erosion or exposure, and lower urinary tract symptoms. Adverse events were infrequent.

Postoperative SUI may be lower with partial mesh removal compared with total mesh removal. Other outcomes were similar regardless of the amount of mesh removed.

PROSPERO, CRD 42018093099.

Obstetrics and gynecology. 2022 Jan 06 [Epub ahead of print]

Paula Jaye Doyle, Cara L Grimes, Ethan M Balk, Cecilia Wieslander, Monica Richardson, Mamta M Mamik, Ambereen Sleemi, Alexandriah Alas, Bela Kudish, Andrew J Walter, Sarit Aschkenazi, Saifuddin Mama, Mohamed Foda, Kate V Meriwether

Departments of Obstetrics and Gynecology and Urology, University of Rochester School of Medicine and Dentistry, Rochester, New York; the Departments of Obstetrics and Gynecology and Urology, New York Medical College, Valhalla, New York; the Center for Evidence Synthesis in Health, Brown School of Public Health, Brown University, Providence, Rhode Island; the Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, California; the Department of Obstetrics and Gynecology, Harvard Medical School, Boston, Massachussetts; the Department of Obstetrics and Gynecology, Albert Einstein College of Medicine, New York, New York; International Medical Response, Brooklyn, New York; the Department of Obstetrics and Gynecology, University of Texas Health Science Center San Antonio, San Antonio, Texas; Bela Vida Urogynecology, Celebration, Florida; the Department of Obstetrics and Gynecology, the Permanente Medical Group, Roseville, California; the Department of Obstetrics and Gynecology, Medical College of Wisconsin, Waukesha, Wisconsin; the Department of Obstetrics and Gynecology, Cooper Medical School of Rowan University, Camden, New Jersey; the Department of Obstetrics and Gynecology, HCA/UCF Consortium, Gainesville, Florida; and the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics & Gynecology, University of New Mexico, Albuquerque, New Mexico.