AUA 2013: Mesh removal often means more incontinence surgery

Mesh removal after suburethral sling procedures led to additional incontinence surgery in more than half of patients, including many who were continent prior to sling removal, a study of almost 100 patients showed.

About 20% of patients reported being continent before or after sling removal. Three-fourths of patients who were continent prior to sling removal had incontinence afterward.

“Incontinence after mesh removal is a significant adverse effect that patients should be appropriately counseled about preoperatively,” said study co-author Leah Nakamura, MD, of UCLA.

Though removal of mesh slings has become more frequent, little information exists about outcomes after sling removal. Dr. Nakamura, working with Shlomo Raz, MD, and colleagues, presented results from a retrospective review of outcomes after sling removal in 96 female patients.

Symptoms leading to mesh removal included obstructive/irritative urinary symptoms in 77 patients, mesh exposure in 46 patients, pain in 41 patients, and recurrent infections in 23 patients. Prior to mesh removal, 18.9% of patients reported being continent.

Removal procedures involved retropubic slings in 45 patients, transobturator slings in 41 patients, mini slings in two patients, and multiple slings in seven patients. Dr. Nakamura reported that 51 patients underwent removal of the entire mesh, and the mesh was partially removed in the remaining 45 patients. In 15 cases, mesh or autologous fascia slings were placed at the same time as removal of the existing sling.

Following mesh removal, 23.5% of patients who were continent before surgery reported being continent afterward. Of the remaining patients, 41.2% reported urinary stress, 11.7% had urge symptoms, 17.7% had mixed symptoms, and 5.9% had continuous incontinence.

Subsequently, 44.7% of patients who were continent prior to mesh removal required additional surgery for urinary incontinence.

The entire cohort underwent 68 additional surgical procedures for incontinence, including 16 patients who required more than one procedure.