European Journal of Obstetrics & Gynecology and Reproductive Biology
Risk factors for mesh erosion after vaginal sling procedures for urinary incontinence
Introduction
Stress urinary incontinence (SUI) is the most common type of urinary incontinence and is generally treated surgically [1], [2]. Vaginal sling procedures have become the standard technique for the surgical treatment of SUI, in which synthetic mesh material is located suburethrally under the vaginal mucosa. The tension-free vaginal tape (TVT) procedure, developed by Ulmsten et al. in 1996, was one of the first retropubic midurethral sling procedures [3], [4]. During this procedure, approaching the posterior pubic cavity may cause bladder perforation and vessel, nerve or bowel injuries. As such, the transobturator tape (TOT) procedure was developed more recently to minimize associated morbidity [5]. Studies have demonstrated that these procedures are very effective and have similar cure rates for SUI [6], [7]. However, using synthetic tape material may have complications such as rejection, infection and erosion [8]. Hence, concerns about mesh complications have made these procedures controversial.
A literature review undertaken by the US Food and Drug Administration found that mesh erosion through the vagina is one of the most common complications following transvaginal procedures that use meshes. Several factors contribute to the wide range of vaginal erosion rates, including patient characteristics (e.g. age and oestrogen deficiency), operative technique, implant size and specific properties of the graft material (e.g. pore size, stiffness, elasticity and basic tissue compatibility) [9]. This study aimed to identify the risk factors for mesh erosion in women undergoing vaginal sling procedures for SUI with synthetic meshes, and to determine the incidence of mesh erosion after these procedures.
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Materials and methods
This retrospective study consisted of 1439 women who had undergone vaginal sling procedures for SUI at the Department of Obstetrics and Gynaecology, Zekai Tahir Burak Woman's Health Education and Research Hospital, Ankara, Turkey, from January 2007 to January 2013. Ethical approval was obtained from the regional hospital ethics committee. Five hundred and sixty-six women underwent TVT procedures and 873 women underwent TOT procedures. All procedures were performed using meshes of the same type
Results
During the study period, 1439 vaginal sling procedures for SUI were performed. Postoperative mesh erosion occurred in 61 patients (4.2%): 41 (67.2%) TOT and 20 (32.8%) TVT procedures. All mesh erosions were located in the midline.
The characteristics of the case and control groups are shown in Table 1. The mean ± standard deviation age of cases was significantly higher than that of controls (50.57 ± 8.33 vs 46.69 ± 7.34, respectively). Mean body mass index (BMI) was significantly lower in controls
Comment
Over the last decade, suburethral sling procedures, using synthetic meshes, have gradually become the primary surgical management for SUI in females. Their popularity is related to the avoidance of a secondary harvesting site, decreased surgical time and similar efficacy in comparison with autologous slings [11]. However, the increasing use of synthetic material has given rise to a wide variety of complications such as mesh erosion, infection, retraction and pelvic pain [12]. The incidence of
Funding
None declared.
Condensation
Awareness of the risk factors associated with mesh erosion following midurethral sling procedures may help surgeons to minimize the complication rate.
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