Skip to main content

Advertisement

SpringerLink
Log in

The impact of midurethral sling surgery on the development of urinary tract infections

  • Original Article
  • Published:
International Urogynecology Journal Aims and scope Submit manuscript

Abstract

Purpose/Objective

To measure the impact of the placement of a midurethral sling (MUS) on development of urinary tract infections (UTI) in women with stress urinary incontinence.

Methods

This is an analysis of a large managed care organization MUS database from 2005 to 2016. The database was queried to identify UTI and diagnosis of recurrent UTI. The primary outcome was the UTI rate after MUS. Secondary outcomes included the recurrent UTI rate and rates of UTI over time.

Results

Over the study period, 13,404 MUS were performed. In the 12 postoperative months, 23% of patients developed a UTI, while 4% developed a de novo recurrent UTI diagnosis. UTIs were most frequently diagnosed in the 1st month, with the 7th postoperative day the most common. Predictors of UTI development included increased age (OR 3.69 [95% CI 2.58–5.26]), being diabetic (OR 1.43 [95% CI 1.28–1.60]), and having urinary retention requiring prolonged catheterization (OR 2.45 [95% CI 2.11–2.85]). UTIs were less likely to be diagnosed in those with transobturator MUS (OR 0.85 [95% CI 0.78–0.94]). Patients who developed a UTI were more likely to have a reoperation (p = 0.0147), including a reoperation for mesh revision/removal (p = 0.0287), and recurrent SUI (p = 0.0394). Patients who developed a UTI were more likely to develop postoperative de novo urgency urinary incontinence (UUI) (p < 0.0001).

Conclusion

Patients are at risk of UTI and rUTI after MUS. Risk of developing UTIs decreases with time. Predictors of developing UTI can help surgeons in the care of patients after MUS.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Considerations about Surgical Mesh for SUI | FDA. https://www.fda.gov/medical-devices/urogynecologic-surgical-mesh-implants/considerations-about-surgical-mesh-sui. Accessed August 2, 2020

  2. Ford AA, Rogerson L, Cody JD, Aluko P, Ogah JA. Mid-urethral sling operations for stress urinary incontinence in women. Cochrane Database Syst Rev. 2017;2017(7):CD006375. https://doi.org/10.1002/14651858.CD006375.pub4.

    Article  PubMed Central  Google Scholar 

  3. Barber MD, Brubaker L, Burgio KL, et al. Comparison of 2 transvaginal surgical approaches and perioperative behavioral therapy for apical vaginal prolapse: the OPTIMAL randomized trial. JAMA. 2014;311(10):1023–34. https://doi.org/10.1001/jama.2014.1719.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Foxman B. Epidemiology of urinary tract infections: Incidence, morbidity, and economic costs. Am J Med. 2002;113(1 Suppl. 1):5–13. https://doi.org/10.1016/S0002-9343(02)01054-9.

    Article  Google Scholar 

  5. Hu KK, Boyko EJ, Scholes D, et al. Risk factors for urinary tract infections in postmenopausal women. Arch Intern Med. 2004;164(9):989–93. https://doi.org/10.1001/archinte.164.9.989.

    Article  PubMed  Google Scholar 

  6. Nygaard I, Brubaker L, Chai TC, et al. Risk factors for urinary tract infection following incontinence surgery https://doi.org/10.1007/s00192-011-1429-9.

  7. Hammett J, Lukman R, Oakes M, Whitcomb EL. Recurrent urinary tract infection after midurethral sling. Female Pelvic Med Reconstr Surg. 2016;22(6):438–41. https://doi.org/10.1097/SPV.0000000000000308.

    Article  PubMed  Google Scholar 

  8. Weintraub AY, Reuven Y, Paz-Levy D, et al. Prevalence and risk factors for urinary tract infection up to one year following midurethral sling incontinence surgery. Eur J Obstet Gynecol Reprod Biol. 2018;222:146–50. https://doi.org/10.1016/j.ejogrb.2018.01.028.

    Article  PubMed  Google Scholar 

  9. Nygaard I, Brubaker L, Chai TC, et al. Risk factors for urinary tract infection following incontinence surgery. Int Urogynecol J. 2011;22(10):1255–65. https://doi.org/10.1007/s00192-011-1429-9.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Nguyen JN, Jakus-Waldman SM, Walter AJ, White T, Menefee SA. Perioperative complications and reoperations after incontinence and prolapse surgeries using prosthetic implants. Obstet Gynecol. 2012;119(3):539–46. https://doi.org/10.1097/AOG.0b013e3182479283.

    Article  PubMed  Google Scholar 

  11. Groutz A, Levin I, Gold R, Pauzner D, Lessing JB, Gordon D. “Inside-out” transobturator tension-free vaginal tape for management of occult stress urinary incontinence in women undergoing pelvic organ prolapse repair. Urology. 2010;76(6):1358–61. https://doi.org/10.1016/j.urology.2010.04.070.

    Article  PubMed  Google Scholar 

  12. Gehrich AP, Patzwald JR, Kern ME, Squires CC, Lustik MB. The incidence of early and recurrent urinary tract infections after midurethral sling operations. Mil Med. 2014;179(11):1301–6. https://doi.org/10.7205/MILMED-D-14-00122.

    Article  PubMed  Google Scholar 

  13. Berger AA, Tan-Kim J, Menefee SA. Long-term risk of reoperation after synthetic mesh midurethral sling surgery for stress urinary incontinence. Obstet Gynecol. 2019;134(5):1047–55. https://doi.org/10.1097/AOG.0000000000003526.

    Article  PubMed  Google Scholar 

  14. Gould MK, Tang T, Liu ILA, et al. Recent trends in the identification of incidental pulmonary nodules. Am J Respir Crit Care Med. 2015;192(10):1208–14. https://doi.org/10.1164/rccm.201505-0990OC.

    Article  PubMed  Google Scholar 

  15. Anger JT, Litwin MS, Wang Q, Pashos CL, Rodríguez LV. Complications of sling surgery among female medicare beneficiaries. Obstet Gynecol. 2007;109(3):707–14. https://doi.org/10.1097/01.AOG.0000255975.24668.f2.

    Article  PubMed  Google Scholar 

  16. Doganay M, Cavkaytar S, Kokanali MK, Ozer I, Aksakal OS, Erkaya S. Risk factors for postoperative urinary tract infection following midurethral sling procedures. Eur J Obstet Gynecol Reprod Biol. 2017;211:74–7. https://doi.org/10.1016/j.ejogrb.2017.02.006.

    Article  PubMed  Google Scholar 

  17. Vigil HR, Mallick R, Nitti VW, Lavallée LT, Breau RH, Hickling DR. Risk factors for urinary tract infection following mid urethral sling surgery. J Urol. 2017;197(5):1268–73. https://doi.org/10.1016/j.juro.2016.12.093.

    Article  PubMed  Google Scholar 

  18. Schimpf MO, Rahn DD, Wheeler TL, et al. Sling surgery for stress urinary incontinence in women: A systematic review and metaanalysis. Am J Obstet Gynecol. 2014;211(1):71.e1–71.e27. https://doi.org/10.1016/j.ajog.2014.01.030.

    Article  Google Scholar 

  19. Ripperda CM, Kowalski JT, Chaudhry ZQ, et al. Predictors of early postoperative voiding dysfunction and other complications following a midurethral sling. Am J Obstet Gynecol. Mosby Inc. 2016;215:656.e1–6. https://doi.org/10.1016/j.ajog.2016.06.010.

    Article  Google Scholar 

  20. Jackson D, Higgins E, Bracken J, Yandell PM, Shull B, Foster RT. Antibiotic prophylaxis for urinary tract infection after midurethral sling: a randomized controlled trial. Female Pelvic Med Reconstr Surg. 2013;19(3):137–41. https://doi.org/10.1097/SPV.0b013e318285ba53.

    Article  PubMed  Google Scholar 

  21. Swartz M, Ching C, Gill B, et al. Risk of infection after Midurethral synthetic sling surgery: are postoperative antibiotics necessary? Urology. 2010;75(6):1305–8. https://doi.org/10.1016/j.urology.2009.11.081.

    Article  PubMed  Google Scholar 

  22. Foxman B, Cronenwett AEW, Spino C, Berger MB, Morgan DM. Cranberry juice capsules and urinary tract infection after surgery: Results of a randomized trial. Am J Obstet Gynecol. 2015;213(2):194.e1–8. https://doi.org/10.1016/j.ajog.2015.04.003.

    Article  Google Scholar 

Download references

Acknowledgments

The research is supported by a grant from the Regional Research Committee of Kaiser Permanente Southern California, grant no. KP-RRC-20171101. The authors thank Stephanie Tovar for her coordination of support and resources at the regional research committee. The authors thank Zoe Li for assistance with data management. The authors thank Liz Walton-Paxton and her team for assistance with mesh implant registry applications.

Author information

Authors and Affiliations

  1. Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Female Pelvic Medicine and Reconstructive Surgery, University of California-San Francisco, San Francisco, CA, USA

    Alexander A. Berger

  2. Ob/Gyn Department, 3250 Fordham Street, Bldg A, San Diego, CA, 92110, USA

    Alexander A. Berger

  3. Department of OB/GYN, Division of Female Pelvic Medicine and Reconstructive Surgery, Kaiser Permanente, San Diego, CA, USA

    Jasmine Tan-Kim & Shawn A. Menefee

Authors
  1. Alexander A. Berger
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jasmine Tan-Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shawn A. Menefee
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alexander A. Berger.

Ethics declarations

Conflict of interest

None.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Berger, A.A., Tan-Kim, J. & Menefee, S.A. The impact of midurethral sling surgery on the development of urinary tract infections. Int Urogynecol J 33, 829–834 (2022). https://doi.org/10.1007/s00192-021-04779-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00192-021-04779-x

Keywords

Search

Navigation