Long-term Rate of Mesh Sling Removal Following Midurethral Mesh Sling Insertion Among Women With Stress Urinary Incontinence

Abstract

<div class="section"> <a class="named-anchor" id="ab-joi180120-1"> <!-- named anchor --> </a> <h5 class="section-title" id="d5657899e326">Question</h5> <p id="d5657899e328">What are the long-term mesh removal rates following midurethral mesh sling insertion among women with stress urinary incontinence? </p> </div><div class="section"> <a class="named-anchor" id="ab-joi180120-2"> <!-- named anchor --> </a> <h5 class="section-title" id="d5657899e331">Findings</h5> <p id="d5657899e333">In this retrospective cohort study that included 95 057 women who underwent midurethral mesh sling insertion for stress urinary incontinence, the rate of sling removal was 3.3% at 9 years. </p> </div><div class="section"> <a class="named-anchor" id="ab-joi180120-3"> <!-- named anchor --> </a> <h5 class="section-title" id="d5657899e336">Meaning</h5> <p id="d5657899e338">These findings may inform decision making when choosing treatment for stress urinary incontinence. </p> </div><div class="section"> <a class="named-anchor" id="ab-joi180120-4"> <!-- named anchor --> </a> <h5 class="section-title" id="d5657899e342">Importance</h5> <p id="d5657899e344">There is concern about outcomes of midurethral mesh sling insertion for women with stress urinary incontinence. However, there is little evidence on long-term outcomes. </p> </div><div class="section"> <a class="named-anchor" id="ab-joi180120-5"> <!-- named anchor --> </a> <h5 class="section-title" id="d5657899e347">Objective</h5> <p id="d5657899e349">To examine long-term mesh removal and reoperation rates in women who had a midurethral mesh sling insertion for stress urinary incontinence. </p> </div><div class="section"> <a class="named-anchor" id="ab-joi180120-6"> <!-- named anchor --> </a> <h5 class="section-title" id="d5657899e352">Design, Setting, and Participants</h5> <p id="d5657899e354">This population-based retrospective cohort study included 95 057 women aged 18 years or older who had a first-ever midurethral mesh sling insertion for stress urinary incontinence in the National Health Service hospitals in England between April 1, 2006, and December 31, 2015. Women were followed up until April 1, 2016. </p> </div><div class="section"> <a class="named-anchor" id="ab-joi180120-7"> <!-- named anchor --> </a> <h5 class="section-title" id="d5657899e357">Exposures</h5> <p id="d5657899e359">Patient and hospital factors and retropubic or transobturator mesh sling insertions.</p> </div><div class="section"> <a class="named-anchor" id="ab-joi180120-8"> <!-- named anchor --> </a> <h5 class="section-title" id="d5657899e362">Main Outcomes and Measures</h5> <p id="d5657899e364">The primary outcome was the risk of midurethral mesh sling removal (partial or total) and secondary outcomes were reoperation for stress urinary incontinence and any reoperation including mesh removal, calculated with death as competing risk. A multivariable Fine-Gray model was used to calculate subdistribution hazard ratios as estimates of relative risk. </p> </div><div class="section"> <a class="named-anchor" id="ab-joi180120-9"> <!-- named anchor --> </a> <h5 class="section-title" id="d5657899e367">Results</h5> <p id="d5657899e369">The study population consisted of 95 057 women (median age, 51 years; interquartile range, 44-61 years) with first midurethral mesh sling insertion, including 60 194 with retropubic insertion and 34 863 with transobturator insertion. The median follow-up time was 5.5 years (interquartile range, 3.2-7.5 years). The rate of midurethral mesh sling removal was 1.4% (95% CI, 1.3%-1.4%) at 1 year, 2.7% (95% CI, 2.6%-2.8%) at 5 years, and 3.3% (95% CI, 3.2%-3.4%) at 9 years. Risk of removal declined with age. The 9-year removal risk after transobturator insertion (2.7% [95% CI, 2.4%-2.9%]) was lower than the risk after retropubic insertion (3.6% [95% CI, 3.5%-3.8%]; subdistribution hazard ratio, 0.72 [95% CI, 0.62-0.84]). The rate of reoperation for stress urinary incontinence was 1.3% (95% CI, 1.3%-1.4%) at 1 year, 3.5% (95% CI, 3.4%-3.6%) at 5 years, and 4.5% (95% CI, 4.3%-4.7%) at 9 years. The rate of any reoperation, including mesh removal, was 2.6% (95% CI, 2.5%-2.7%) at 1 year, 5.5% (95% CI, 5.4%-5.7%) at 5 years, and 6.9% (95% CI, 6.7%-7.1%) at 9 years. </p> </div><div class="section"> <a class="named-anchor" id="ab-joi180120-10"> <!-- named anchor --> </a> <h5 class="section-title" id="d5657899e372">Conclusions and Relevance</h5> <p id="d5657899e374">Among women undergoing midurethral mesh sling insertion, the rate of mesh sling removal at 9 years was estimated as 3.3%. These findings may guide women and their surgeons when making decisions about surgical treatment of stress urinary incontinence. </p> </div><p class="first" id="d5657899e377">This cohort study of women who underwent midurethral sling insertion for stress urinary incontinence at hospitals in England between 2006 and 2015 investigates rates of sling removal or reoperation for incontinence. </p>