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Comparison of synthetic mesh erosion and chronic pain rates after surgery for pelvic organ prolapse and stress urinary incontinence: a systematic review

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Abstract

Background

The aim of this study is to systematically compare rates of erosion and chronic pain after mesh insertion for pelvic organ prolapse (POP) and stress urinary incontinence (SUI) surgery.

Methods

A systematic electronic search was performed on studies that evaluated the incidence of erosion and chronic pain after mesh insertion for POP or SUI. The primary outcome measurement was to compare mesh erosion rates for POP and SUI surgery. Secondary outcome measurements were incidence of de novo pain and a comparison of patient demographics for both surgeries.

Results

Twenty-six studies on 292,606 patients (n = 9077 for POP surgery and n = 283,529 for SUI surgery) met the inclusion criteria. Median follow-up was 26.38 ± 22.17 months for POP surgery and 39.33 ± 27.68 months for SUI surgery. Overall, the POP group were older (p < 0.0001) and had a lower BMI (p < 0.0001). Mesh erosion rates were significantly greater in the POP group compared to the SUI group (4% versus 1.9%) (OR 2.13; 95% CI 1.91–2.37; p < 0.0001). The duration from surgery to onset of mesh erosion was 306.84 ± 183.98 days. There was no difference in erosion rates between abdominal and transvaginal mesh for POP. There was no difference in erosion rates between the transobturator and retropubic approach for SUI. The incidence of chronic pain was significantly greater in the POP group compared to the SUI group (6.7% versus 0.6%) (OR 11.02; 95% CI 8.15–14.9; p < 0.0001). The duration from surgery to onset of chronic pain was 325.88 ± 226.31 days.

Conclusions

The risk of mesh erosion and chronic pain is significantly higher after surgery for POP compared to SUI. These significant complications occur within the first year after surgery.

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Abbreviations

SUI:

stress urinary incontinence

POP:

pelvic organ prolapse

MUS:

mid-urethral sling

BMI:

body mass index

PP:

polypropylene

TVT:

tension-free vaginal tape

TOT:

transobturator tape

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Funding

This research was funded by the RCSI-Blackrock Clinic StAR MD programme 2020.

Author information

Authors and Affiliations

  1. Royal College of Surgeons in Ireland, Tissue Engineering Research Group, Dublin, Ireland

    Eoin MacCraith, Eoghan M. Cunnane, Michael Joyce, James C. Forde, Fergal J. O’Brien & Niall F. Davis

  2. Blackrock Clinic, Dublin, Ireland

    Eoin MacCraith, James C. Forde & Niall F. Davis

Authors
  1. Eoin MacCraith
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  2. Eoghan M. Cunnane
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  3. Michael Joyce
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  4. James C. Forde
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  5. Fergal J. O’Brien
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  6. Niall F. Davis
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Contributions

E MacCraith: manuscript writing; EM Cunnane: data collection, manuscript writing; M Joyce: data collection; FJ O’Brien: project development; JC Forde: manuscript writing; NF Davis: project development, manuscript writing.

Corresponding author

Correspondence to Eoin MacCraith.

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Ethics statement

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1975 Helsinki Declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

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MacCraith, E., Cunnane, E.M., Joyce, M. et al. Comparison of synthetic mesh erosion and chronic pain rates after surgery for pelvic organ prolapse and stress urinary incontinence: a systematic review. Int Urogynecol J 32, 573–580 (2021). https://doi.org/10.1007/s00192-020-04612-x

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  • DOI: https://doi.org/10.1007/s00192-020-04612-x

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