The Risk of Recurrent Urinary Incontinence Requiring Surgery after Suburethral Sling Removal for Mesh Complications

We sought to examine the risk of recurrent stress urinary incontinence (SUI) after suburethral sling mesh removal or excision.

We conducted a retrospective cohort study of patients who were continent before removal or excision of synthetic mid-urethral slings; this cohort of 278 subjects was much larger than seen in previous such studies. Patients with preoperative incontinence, additional vaginal mesh placements, prior mesh revision/excision, existing SUI, and prior pelvic radiation or fistula were excluded. Only patients with follow-up detailing continence status within 1 year of mesh removal were examined.

Of 278 patients, 117 (70 retropubic and 47 transobturator) mid-urethral sling removals met inclusion criteria. Demographic data were comparable between groups. Presenting symptoms were also similar, with similar extrusion rates. Chronic pain was the reason for mesh removal in 80% of cases. In one year of follow-up, 38.6% (27/70) retropubic and 34.0% (16/47) transobturator sling removals had SUI requiring an anti-incontinence procedure. Total sling mesh removal was performed in 51.4% of RVM and 51.1% of TOM cases.

In this continent population with sling complications, approximately 1/3 developed significant SUI within one year of mesh removal requiring anti-incontinence surgery, regardless of the amount or type of mesh removed. Total mesh removal did not increase SUI risk.

Urology. 2017 May 02 [Epub ahead of print]

P Ramart, A L Ackerman, S Cohen, J H Kim, S Raz

Division of Urology, Department of Surgery, Siriraj Hospital, Mahidol University, Thailand., Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA. Electronic address: ., David Geffen School of Medicine at UCLA, Los Angeles, CA.