By: 15 October 2015
Low rate of secondary surgeries following a vaginal mesh sling for SUI

Low rate of secondary surgeries following a vaginal mesh sling for SUI

A follow-up of nearly 60,000 women who received a synthetic vaginal mesh sling for the treatment of stress urinary incontinence (SUI) finds the risk is low for needing a second surgery for mesh removal or revision (about 1 in 30 women ten years after surgery), according to a study published online by JAMA Surgery.

Female SUI is a common condition that is often treated with surgery when conservative management options are unsuccessful. An estimated 1 in 7 women will undergo surgery for SUI during their lifetime. Synthetic mesh slings are the most common surgical treatment. However, in the US, more than 50,000 women have joined class action lawsuits for transvaginal mesh complications resulting from SUI and prolapse procedures, according to background information in the article.

Blayne Welk, of Western University, St Joseph’s Health Care, Ontario, and colleagues measured the incidence of mesh removal or revision after SUI procedures and determined whether significant surgeon and patient risk factors exist. The study included all adult women undergoing a procedure for SUI with synthetic mesh in Ontario, Canada, from April 2002 through December 2012 (n = 59,887).

Overall, 1,307 women (2.2 per cent) underwent mesh removal or revision a median of 0.94 years after receiving a mesh implant for SUI. Patients of high-volume surgeons (75th percentile of yearly mesh-based procedures) had a significantly lower risk for experiencing the composite outcome (surgical procedures related to removal or revision of mesh slings). Gynecologists were not significantly associated with more complications compared with urologists. Multiple mesh-based SUI procedures increased the risk for complications.

“These findings support the regulatory statements that suggest that patients should be counselled regarding serious complications that can occur with mesh-based procedures for SUI and that surgeons should achieve expertise in their chosen procedure. Multiple mesh-based procedures for SUI are a novel risk factor associated with an almost 5-fold higher rate of mesh removal or revision, and the safety of this practice should be studied further,” the authors write.

The researchers note that although the FDA in the past has treated all vaginal mesh implants as equivalent, the intervention rates for mesh-based complications in procedures for SUI appear to be lower than those associated with procedures for pelvic organ prolapse.

Reference: JAMA Surgery. Published online doi:10.1001/jamasurg.2015.2509.

Source: JAMA