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International Urogynecology Journal

, Volume 27, Issue 9, pp 1321–1326 | Cite as

Predictors of vaginal mesh exposure after midurethral sling placement: a case–control study

  • Brian J. Linder
  • Sherif A. El-Nashar
  • Daniel A. Carranza Leon
  • Emanuel C. Trabuco
Original Article

Abstract

Introduction and hypothesis

Female stress urinary incontinence is highly prevalent, and synthetic midurethral sling placement is the most common type of anti-incontinence surgery performed in the USA. We aimed to identify risk factors associated with surgery used to treated vaginal mesh exposure after midurethral sling placement for stress urinary incontinence.

Methods

We identified women who underwent anti-incontinence procedures from January 2002 through December 2012. Patients with vaginal mesh exposure undergoing surgical repair after midurethral sling placement were compared with a control group without mesh exposure in a 1:3 ratio. Patients with ObTape sling placement (Mentor Corporation) were excluded. Logistic regression models were used to evaluate associations between clinical risk factors and vaginal mesh exposure.

Results

Overall, 2,123 patients underwent primary sling placement, with 27 (1.3 %) having vaginal mesh exposure necessitating surgical repair. Patients with mesh exposure were more likely to have undergone previous bariatric surgery (P = 0.008), hemoglobin <13 g/dL (P = 0.006), premenopausal status (P = 0.008), age <50 years (P = 0.001), and the retropubic approach to sling placement (P = 0.03). Multivariate analysis identified these risk factors: previous bariatric surgery (odds ratio [OR], 7.0; 95 % CI, 1.1–61.4), retropubic approach (OR, 5.7; 95 % CI, 1.1–107.0), preoperative hemoglobin <13 g/dL (OR, 2.8; 95 % CI, 1.1–7.5), and premenopausal status (OR, 2.6; 95 % CI, 1.0–7.3). Among postmenopausal patients, those with mesh exposure were significantly more likely to receive preoperative estrogen therapy (OR, 12.4; 95 % CI, 2.7–57.8).

Conclusions

Previous bariatric surgery, retropubic approach, premenopausal status, and lower preoperative hemoglobin were associated with a significantly increased risk of surgery for vaginal mesh exposure after midurethral sling placement. Recognizing these factors can improve preoperative patient counseling.

Keywords

Bariatric surgery Complication Midurethral sling Vaginal exposure 

Abbreviations

AUC

Area under the curve

ROC

Receiver operator characteristic

Notes

Compliance with ethical standards

Conflict of interest

None.

References

  1. 1.
    Wu JM, Vaughan CP, Goode PS, Redden DT, Burgio KL, Richter HE et al (2014) Prevalence and trends of symptomatic pelvic floor disorders in U.S. women. Obstet Gynecol 123(1):141–148CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Wu JM, Matthews CA, Conover MM, Pate V, Jonsson Funk M (2014) Lifetime risk of stress urinary incontinence or pelvic organ prolapse surgery. Obstet Gynecol 123(6):1201–1206CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Geller EJ, Wu JM (2013) Changing trends in surgery for stress urinary incontinence. Curr Opin Obstet Gynecol 25(5):404–409CrossRefPubMedGoogle Scholar
  4. 4.
    Rogo-Gupta L (2013) Current trends in surgical repair of pelvic organ prolapse. Curr Opin Obstet Gynecol 25(5):395–398CrossRefPubMedGoogle Scholar
  5. 5.
    Amundsen CL, Flynn BJ, Webster GD (2003) Urethral erosion after synthetic and nonsynthetic pubovaginal slings: differences in management and continence outcome. J Urol 170(1):134–137CrossRefPubMedGoogle Scholar
  6. 6.
    Ogah J, Cody JD, Rogerson L (2009) Minimally invasive synthetic suburethral sling operations for stress urinary incontinence in women. Cochrane Database Syst Rev 4:CD006375PubMedGoogle Scholar
  7. 7.
    Chen HY, Ho M, Hung YC, Huang LC (2008) Analysis of risk factors associated with vaginal erosion after synthetic sling procedures for stress urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct 19(1):117–121CrossRefPubMedGoogle Scholar
  8. 8.
    Jonsson Funk M, Siddiqui NY, Pate V, Amundsen CL, Wu JM (2013) Sling revision/removal for mesh erosion and urinary retention: long-term risk and predictors. Am J Obstet Gynecol 208(1):73.e1–73.e7CrossRefGoogle Scholar
  9. 9.
    Cadish LA, West EH, Sisto J, Longoria T, Bebchuk JD, Whitcomb EL (2015) Preoperative vaginal estrogen and midurethral sling exposure: a retrospective cohort study. Int Urogynecol J  10.1007/s00192-015-2810-x PubMedGoogle Scholar
  10. 10.
    von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP (2007) STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 370(9596):1453–1457CrossRefGoogle Scholar
  11. 11.
    Rubin G, Wortman M, Kouides PA (2004) Endometrial ablation for von Willebrand disease-related menorrhagia: experience with seven cases. Haemophilia 10(5):477–482CrossRefPubMedGoogle Scholar
  12. 12.
    Harrell FE Jr, Lee KL, Califf RM, Pryor DB, Rosati RA (1984) Regression modelling strategies for improved prognostic prediction. Stat Med 3(2):143–152CrossRefPubMedGoogle Scholar
  13. 13.
    Newcombe RG (1998) Two-sided confidence intervals for the single proportion: comparison of seven methods. Stat Med 17(8):857–872CrossRefPubMedGoogle Scholar
  14. 14.
    Agha-Mohammadi S, Hurwitz DJ (2008) Potential impacts of nutritional deficiency of postbariatric patients on body contouring surgery. Plast Reconstr Surg 122(6):1901–1914CrossRefPubMedGoogle Scholar
  15. 15.
    Barbour JR, Iorio ML, Oh C, Tung TH, O’Neill PJ (2014) Predictive value of nutritional markers for wound healing complications in bariatric patients undergoing panniculectomy. Ann Plast Surg 75(4):435–438CrossRefGoogle Scholar
  16. 16.
    D’Ettorre M, Gniuli D, Iaconelli A, Massi G, Mingrone G, Bracaglia R (2010) Wound healing process in post-bariatric patients: an experimental evaluation. Obes Surg 20(11):1552–1558CrossRefPubMedGoogle Scholar
  17. 17.
    Schimpf MO, Rahn DD, Wheeler TL, Patel M, White AB, Orejuela FJ et al (2014) Society of Gynecologic Surgeons Systematic Review Group. Sling surgery for stress urinary incontinence in women: a systematic review and metaanalysis. Am J Obstet Gynecol 211(1):71.e1–71.e27CrossRefGoogle Scholar
  18. 18.
    Sirls LT, McLennan GP, Killinger KA, Boura JA, Fischer M, Nagaraju P et al (2013) Exploring predictors of mesh exposure after vaginal prolapse repair. Female Pelvic Med Reconstr Surg 19(4):206–209CrossRefPubMedGoogle Scholar
  19. 19.
    Lowman JK, Woodman PJ, Nosti PA, Bump RC, Terry CL, Hale DS (2008) Tobacco use is a risk factor for mesh erosion after abdominal sacral colpoperineopexy. Am J Obstet Gynecol 198(5):561.e1–e4CrossRefGoogle Scholar
  20. 20.
    Sorensen LT (2012) Wound healing and infection in surgery: the pathophysiological impact of smoking, smoking cessation, and nicotine replacement therapy: a systematic review. Ann Surg 255(6):1069–1079CrossRefPubMedGoogle Scholar

Copyright information

© The International Urogynecological Association 2016

Authors and Affiliations

  • Brian J. Linder
    • 1
  • Sherif A. El-Nashar
    • 2
  • Daniel A. Carranza Leon
    • 2
  • Emanuel C. Trabuco
    • 2
  1. 1.Department of UrologyMayo ClinicRochesterUSA
  2. 2.Department of Obstetrics and GynecologyMayo ClinicRochesterUSA

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