Analysis of patient and technical factors associated with midurethral sling mesh exposure and perforation

Osborn, David; Dmochowski, Roger R.; Harris, Catherine; Danford, Jill J; Kaufman, Melissa R.; Mock, Stephen; Kit, Laura Chang; McCormick, Benjamin; Reynolds, W. Stuart

doi:10.1111/iju.12544

Cited by 37 publications

(26 citation statements)

References 23 publications

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“…The true incidence of mesh perforations is unknown, but it is estimated to be 0.7-5 % for retropubic slings and 0-0.5 % for transobturator slings [31,59]. It is unclear whether a mesh perforation results from progressive erosion of the mesh over time or from a missed perforation at the time of the procedure [22].…”

Section: Mesh Perforation and Urinary Fistulamentioning

confidence: 99%

“…In a retrospective review by Osborn et al, 27 patients were identified to have a post-operative MUS perforation (bladder perforation n = 12, urethral perforation n = 15). Of these, 11/27 (41 %) presented with irritative voiding symptoms, 7/11 (26 %) incontinence, 4/11 (15 %) vaginal pain, and 2/11 (7 %) with either recurrent UTIs or dyspareunia [59].…”

Section: Mesh Perforation and Urinary Fistulamentioning

confidence: 99%

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Evaluation and Management of Mid-Urethral Sling Complications

Brown

Cohn

Kaufman

et al. 2016

Curr Bladder Dysfunct Rep

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Currently, a mid-urethral sling is the standard of care for the treatment of female stress urinary incontinence. However, complications can occur that are unique to polypropylene mesh such as mesh exposure, perforation, or contracture. Other complications such as de novo urgency and/or urgency urinary incontinence (UUI), urinary tract infection, and/or urinary obstruction can also occur. The diagnosis of these complications requires a high index of suspicion, and treatment is critical as these complications can be quite morbid. As such, this review will discuss the most recent literature regarding the intraoperative and post-operative evaluation and management of mid-urethral sling complications.

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Section: Mesh Perforation and Urinary Fistulamentioning

confidence: 99%

Section: Mesh Perforation and Urinary Fistulamentioning

confidence: 99%

Evaluation and Management of Mid-Urethral Sling Complications

Brown

Cohn

Kaufman

et al. 2016

Curr Bladder Dysfunct Rep

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“…148,[239][240][241][242] However, in an article published in 2014, the authors concluded that occurrence of bladder and/or urethral perforations during surgery is associated with an almost 26-fold increase in risk of subsequent bladder or urethral mesh erosion. 31 If the findings of this study are accurate, the dictum of simply removing and repassing the trocar after bladder p erforation must be seriously questioned. Limited information is available on urethral complications following perforation, but if a perforation large enough to necessitate repair exists, most would agree that it is best to abandon the SMUS procedure.…”

Section: Reviews Infectionmentioning

confidence: 92%

Safety considerations for synthetic sling surgery

et al. 2015

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Implantation of a synthetic midurethral sling (SMUS) is the most commonly performed anti-incontinence operation in women worldwide. The effectiveness of the SMUS is comparable to that of the historical gold standards--autologous fascial slings and the Burch colposuspension. Much controversy, however, has evolved regarding the safety of this type of sling. Overall, the quality of the studies with respect to assessing risks of SMUS-associated complications is currently poor. The most common risks in patients with SMUS include urethral obstruction requiring surgery (2.3% of patients with SMUS), vaginal, bladder and/or urethral erosion requiring surgery (1.8%) and refractory chronic pain (4.1%); these data likely represent the minimum risks. In addition, the failure rate of SMUS implantation surgery is probably at least 5% in patients with stress urinary incontinence (SUI). Furthermore, at least one-third of patients undergoing sling excision surgery develop recurrent SUI. Considering the additional risks of refractory overactive bladder, fistulas and bowel perforations, among others, the overall risk of a negative outcome after SMUS implantation surgery is ≥15%.

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“…Currently, the gold standard for surgical management of SUI in women is the midurethral sling (MUS), which displays a cure rate of 80-95% [6][7][8]. While MUS has a high success rate, 5-20% of the patients will have persisting incontinence thus needing to undergo sling removal and subsequent treatment [9]. The postoperative complications reach as high as 7.2% for erosion and the risk of getting a perioperative urinary tract infection is 17.2% [10].…”

Section: Aimmentioning

confidence: 99%

Cell-based Therapy for the Treatment of Female Stress Urinary Incontinence: An Early Cost–Effectiveness Analysis

et al. 2018

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Aim:To perform an early cost-effectiveness analysis of in vitro expanded myoblasts (IVM) and minced myofibers versus midurethral slings (MUS) for surgical treatment of female stress urinary incontinence. Methods: Cost-effectiveness and sensitivity analyses were performed using a decision tree comprising previously published data and expert opinions. Results & conclusion: In the base case scenario, MUS was the cost-effective strategy with a negative incremental cost-effectiveness ratio compared with IVM and a positive incremental cost-effectiveness ratio compared with minced myofibers. However, the sensitivity analysis indicates that IVM may become an alternative providing greater effect at a higher cost. With the possibility of becoming more effective, IVM treatment would be advantageous over MUS given its reduced invasiveness and lower risks of complications. Urinary incontinence (UI) is a common medical condition that has a negative impact on the quality of life of individuals of all ages, racial and ethnic groups. The prevalence of UI is about two-to-four-times higher in women than in men, ranging from 11 to 57% [1]. The most common subtype is stress urinary incontinence (SUI), affecting roughly 50% of any women with UI [2]. SUI describes a condition where there is an involuntary leak of urine when intra-abdominal pressure rises, for example, when coughing, sneezing, laughing or during other physical activity. SUI has not only a severe impact on quality of life but it also places a substantial economic burden on the healthcare system and society [3][4][5]. In the USA, for example, it has been estimated that in 1998, the average direct medical cost of SUI amounted US$5642 per patient, while the indirect workplace expenses were US$4208 [3]. Evidence suggests that these costs have experienced an age-related increase over the last years [5].The clinical management of SUI is complex and may involve conservative treatments, such as pelvic floor muscle training and pharmacotherapy, as well as surgical procedures. Currently, the gold standard for surgical management of SUI in women is the midurethral sling (MUS), which displays a cure rate of 80-95% [6][7][8]. While MUS has a high success rate, 5-20% of the patients will have persisting incontinence thus needing to undergo sling removal and subsequent treatment [9]. The postoperative complications reach as high as 7.2% for erosion and the risk of getting a perioperative urinary tract infection is 17.2% [10]. As an alternative to MUS implantation, with the goal of targeting the underlying etiology rather than relieving the symptoms, cell-based therapies (CBTs) have recently emerged [11]. Among the different modalities of CBT, intraurethral injection of autologous skeletal myoblasts appears as one of the most promising regenerative therapies for SUI [12]. While various large-scale clinical trials are still ongoing, results from the initial clinical studies have shown that these approaches appear to be safe and moderately effective. Remarkably, a recent study has shown ...

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Analysis of patient and technical factors associated with midurethral sling mesh exposure and perforation

Cited by 37 publications

References 23 publications

Evaluation and Management of Mid-Urethral Sling Complications

Evaluation and Management of Mid-Urethral Sling Complications

Safety considerations for synthetic sling surgery

Cell-based Therapy for the Treatment of Female Stress Urinary Incontinence: An Early Cost–Effectiveness Analysis

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