Mesh removal frequently results in bladder problems warranting careful investigation, researchers reported at the International Continence Society’s (ICS) 2022 annual meeting in Vienna, Austria.
In a retrospective study, 204 women had a midurethral sling procedure, including placement of tension-free transvaginal tape (TVT; 61.8%), transvaginal tension-free vaginal tape-obturator (20.1%), or transobturator tape (TOT; 21.6%). Seven patients had 2 sling surgeries. Nearly a quarter of patients also had mesh complication surgery. The cohort subsequently underwent mesh removal at the female pelvic medicine and reconstructive surgery division of the University of College London hospital.
Following mesh removal, 80.5% of patients reported symptoms of stress urinary incontinence (SUI), 10.1% reported prolapse symptoms, 8.0% reported voiding dysfunction, and 2.9% reported overactive bladder (OAB). The vast majority experienced pain improvement. None of the patients reported worsening pain.
Video-urodynamics revealed pure SUI in 67.3%, pure detrusor overactivity in 6.8%, and mixed urinary incontinence in 14.3%. Only 1 patient had voiding dysfunction. Urodynamic studies also found that 2 women had urethral stricture and 10 women (9.8%) had a significant cystocele.
Women should be counseled about the risks of midurethral sling surgery, Stefania Palmieri, MD, of the University College London hospital in the UK, and colleagues concluded in their study abstract. Risks may include persistent or recurrent incontinence, urethral stricture, persistent or de novo pain, urethral injury, and urethrovaginal fistula. The investigators emphasized that after continence mesh removal, “patients should be properly investigated through urodynamics studies as the underlying bladder problems may be more complex than suggested by patients’ symptoms only.”
Palmieri S, Gonzales G, Kuria E, Sarfoh R, Elneil S. Post-operative outcomes and urodynamic findings after continence mesh removal. Presented at: ICS 2022; September 7-10. Abstract 155.