Reoperation Unlikely After Midurethral-Sling Surgery Using Synthetic Mesh

By David Douglas

October 22, 2019

NEW YORK (Reuters Health) - Up to nine years after midurethral-sling surgery with synthetic mesh for stress urinary incontinence, only a small minority of women will require reoperation, according to a large retrospective study.

As Dr. Alexander A. Berger told Reuters Health by email, "Our findings provide evidence that there is a low long-term risk of reoperation for both recurrent stress urinary incontinence and mesh revision or removal."

In a paper online October 8 in Obstetrics and Gynecology, Dr. Berger of Kaiser Permanente, in San Diego, California, and colleagues note that although advantages of this minimally invasive approach include "shorter operative and recovery times, and high efficacy rates, there are increasing concerns from the public and medical community with mesh related adverse events."

To further examine the situation, the researchers studied data from the Kaiser Permanente managed-care organization and identified more than 17,000 women who underwent a midurethral sling surgery for stress urinary incontinence between 2005 and 2016.

Overall, at one year the reoperation rate was 2.1%. At five years, it was 4.5% and at nine years it was 6.0%. Asians and Pacific Islanders, who comprised 4.4% of the cohort, had a significantly reduced risk of reoperation (adjusted hazard ratio, 0.41) but no other demographic or perioperative factor played a part.

The reoperation rate for mesh revision or removal was 0.7% at one year, 1.0% at five years and 1.1% at nine years. Corresponding proportions for recurrent stress urinary incontinence were 1.6%, 3.9% and 5.2%. The most likely surgical approach in the latter group was repeat synthetic midurethral sling.

Reoperation was significantly more common after single-incision compared with retropubic sling (aHR, 1.5). The overall reoperation risk and risk of reoperation for recurrent stress urinary incontinence, say the researchers, "are similar to previous studies."

"This study," Dr. Berger concluded, "contributes to the growing medical evidence on the safety and efficacy of the synthetic-mesh midurethral sling for the treatment of women with stress urinary incontinence."


Obstet Gynecol 2019.