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Outcome of surgical management for midurethral sling complications: a multicentre retrospective cohort study

  • Victoria KershawEmail author
  • Rachel Nicholson
  • Paul Ballard
  • Aethele Khunda
  • Santhosh Puthuraya
  • Elaine Gouk
Original Article
First Online:

Abstract

Introduction and hypothesis

Suspension of midurethral sling (MUS) surgery in the UK has led to a call for further evidence regarding long-term morbidity and the efficacy of treatments when mesh complications are encountered. We reviewed how many patients who underwent MUS surgery in Teesside, UK, returned to theatre due to a complication and what the outcomes were following this surgical intervention.

Methods

All patients coded to have undergone an MUS procedure between 1 January 2010 and 31 December 2014 in Teesside were reviewed retrospectively (n = 924). Case notes were analysed for patients who returned to theatre up until December 2017 due to complications related to their original MUS.

Results

Seventy-one of 924 (7.7%) women returned to theatre for some form of surgical intervention. There was a statistically significant difference in return-to-theatre rate between the transobturator and retropubic approach groups (63/661; 9.5%; confidence interval (CI) 7.3–11.8% v 8/263; 3.0%; CI 0.96%, 5.1%, odds ratio (OR) 3.35, p = 0.001); 2.8% (26/924) underwent shortening, reburying, incision or MUS excision; 1.0% (9/924) underwent steroid injection along the MUS tract; 1.7% (16/924) underwent surgical treatment of detrusor overactivity; 3.0% (28/924) required further stress incontinence surgery. The risk of unresolved chronic pain post-MUS surgery following treatment of complications was 0.2% (2/924).

Conclusions

Our results show a reassuringly low rate of mesh removal following MUS surgery. Furthermore, outcomes were good following surgical management of MUS complications. We advocate compulsory registration of all MUS procedures, follow-up data and complications to provide robust long-term evidence for the future.

Keywords

Complication Midurethral sling Mesh Stress incontinence TVT  TOT 
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Notes

Compliance with ethical standards

Conflicts of interest

V Kershaw: None.

R Nicholson: None.

P Ballard: None.

A Khunda: Received an educational travel grant from Medtronic plc.

S Puthuraya: None.

E Gouk: None.

References

  1. 1.
    “Scandal” of vaginal mesh removal rates revealed by NHS records. Available from: https://www.theguardian.com/society/2017/aug/15/scandal-of-vaginal-mesh-removal-rates-revealed-by-nhs-records. Accessed 10 Oct 2018.
  2. 2.
    More than 800 women sue NHS and manufacturers over vaginal mesh implants. Available from: https://www.theguardian.com/society/2017/apr/18/more-than-800-women-sue-nhs-and-manufacturers-over-vaginal-mesh-implants. Accessed 10 Oct 2018.
  3. 3.
    Mesh Working Group Interim Report. Available from: https://www.england.nhs.uk/wp-content/uploads/2015/12/mesh-wg-interim-rep.pdf. Accessed 10 Oct 2018.
  4. 4.
    Varley D (2012) Summaries of the safety/adverse effects of vaginal tapes/slings/meshes for stress urinary incontinence and prolapse. 1–72. Available from: http://www.mhra.gov.uk/home/groups/commsic/documents/websiteresources/con205383.pdf. Accessed 10 Oct 2018.
  5. 5.
    Keltie K, Elneil S, Monga A, et al. Complications following vaginal mesh procedures for stress urinary incontinence: an 8 year study of 92,246 women. Sci Rep. 2017;7:12015.  https://doi.org/10.1038/s41598-017-11821-w.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Ford AA, Rogerson L, Cody JD, et al. Mid-urethral sling operations for stress urinary incontinence in women. Cochrane Database Syst Rev. 2017;7:CD006375.  https://doi.org/10.1002/14651858.CD006375.pub4.CrossRefPubMedGoogle Scholar
  7. 7.
  8. 8.
    Mesh Oversight Group Report. Available from: https://www.england.nhs.uk/wp-content/uploads/2017/07/mesh-oversight-group-report.pdf. Accessed 10 Oct 2018.
  9. 9.
    Opinion on The safety of surgical meshes used in urogynecological surgery. Available from: https://ec.europa.eu/health/scientific_committees/emerging/docs/scenihr_o_049.pdf. Accessed 10 Oct 2018.
  10. 10.
    Morling JR, McAllister DA, Agur W, et al. Adverse events after first, single, mesh and non-mesh surgical procedures for stress urinary incontinence and pelvic organ prolapse in Scotland, 1997-2016: a population-based cohort study. Lancet. 2017;389:629–40.  https://doi.org/10.1016/S0140-6736(16)32572-7.CrossRefPubMedGoogle Scholar
  11. 11.
    Women harmed because vaginal mesh regulation “not fit for purpose.” Available from: https://www.theguardian.com/society/2017/dec/06/woman-great-harm-due-loopholes-vaginal-mesh-regulation. Accessed 10 Oct 2018.
  12. 12.
    Parliamentary debate- surgical mesh implants. Available from: http://hansard.parliament.uk/commons/2017-10-18/debates/B546B1F1-099F-442C-AD71-0185D1B3F69C/SurgicalMeshImplants. Accessed 10 Oct 2018.
  13. 13.
    NHS Improvement Provider bulletin 25 July 2018. Available from: https://improvement.nhs.uk/news-alerts/provider-bulletin-25-july-2018/. Accessed 10 Oct 2018.
  14. 14.
    Recommendations of the Mesh Pause Clinical Advisory Group to Medical Directors and Surgical Teams. Available from: https://www.rcog.org.uk/globalassets/documents/guidelines/safety-alerts/meshclinicaladvisorygroupcmoadvice.pdf. Accessed 10 Oct 2018.
  15. 15.
    Glazener CM, Breeman S, Elders A, et al. Mesh, graft, or standard repair for women having primary transvaginal anterior or posterior compartment prolapse surgery: two parallel-group, multicentre, randomised, controlled trials (PROSPECT). Lancet. 2017;389:381–92.  https://doi.org/10.1016/S0140-6736(16)31596-3.CrossRefPubMedGoogle Scholar
  16. 16.
    Jha S, Cutner A, Moran P. The UK national prolapse survey: 10 years on. Int Urogynecol J. 2018;29:795–801.  https://doi.org/10.1007/s00192-017-3476-3.CrossRefPubMedGoogle Scholar
  17. 17.
    BSUG- Definition of a Urogynaecologist. Available from: http://www.bsug.org.uk/pages/about/definition-of-urogynaecologist/84. Accessed 10 Oct 2018.
  18. 18.
    Long C-Y, Lo T-S, Liu C-M, et al. Lateral excision of tension-free vaginal tape for the treatment of iatrogenic urethral obstruction. Obstet Gynecol. 2004;104:1270–4.  https://doi.org/10.1097/01.AOG.0000146282.51404.93.CrossRefPubMedGoogle Scholar
  19. 19.
    Roth TM. Management of persistent groin pain after transobturator slings. Int Urogynecol J Pelvic Floor Dysfunct. 2007;18:1371–3.  https://doi.org/10.1007/s00192-007-0365-1.CrossRefPubMedGoogle Scholar
  20. 20.
    Duckett JRA, Jain S. Groin pain after a tension-free vaginal tape or similar suburethral sling: management strategies. BJU Int. 2005;95:95–7.  https://doi.org/10.1111/j.1464-410X.2004.05258.x.CrossRefPubMedGoogle Scholar
  21. 21.
    Management of vaginal mesh erosion following the tension free vaginal; tape procedure: five years experience at a UK tertiary referral centre. Available from: https://www.ics.org/Abstracts/Publish/105/000763.pdf. Accessed 10 Oct 2018.
  22. 22.
    Welk B, Al-Hothi H, Winick-Ng J. Removal or revision of vaginal mesh used for the treatment of stress urinary incontinence. JAMA Surg. 2015;150:1167–75.  https://doi.org/10.1001/jamasurg.2015.2590.CrossRefPubMedGoogle Scholar
  23. 23.
    Lanier ST, Wang ED, Chen JJ, et al. The effect of acellular dermal matrix use on complication rates in tissue expander/implant breast reconstruction. Ann Plast Surg. 2010;64:674–8.  https://doi.org/10.1097/SAP.0b013e3181dba892.CrossRefPubMedGoogle Scholar
  24. 24.
    Matharu GS, Pynsent PB, Dunlop DJ. Revision of metal-on-metal hip replacements and resurfacings for adverse reaction to metal debris: a systematic review of outcomes. Hip Int. 2014;24:311–20.  https://doi.org/10.5301/hipint.5000140.CrossRefPubMedGoogle Scholar
  25. 25.
    Albino FP, Patel KM, Nahabedian MY, et al. Does mesh location matter in abdominal wall reconstruction? A systematic review of the literature and a summary of recommendations. Plast Reconstr Surg. 2013;132:1295–304.  https://doi.org/10.1097/PRS.0b013e3182a4c393.CrossRefPubMedGoogle Scholar
  26. 26.
    Noblett K, Benson K, Kreder K. Detailed analysis of adverse events and surgical interventions in a large prospective trial of sacral neuromodulation therapy for overactive bladder patients. Neurourol Urodyn. 2017;36:1136–9.  https://doi.org/10.1002/nau.23076.CrossRefPubMedGoogle Scholar
  27. 27.
    Balzarro M, Rubilotta E, Goss C, et al. Counseling in urogynecology: a difficult task, or simply good surgeon-patient communication? Int Urogynecol J. 2018;29:943–8.  https://doi.org/10.1007/s00192-018-3673-8.CrossRefPubMedGoogle Scholar
  28. 28.
    NICE Guideline 171: Urinary Incontinence in Women. Available from: https://www.nice.org.uk/guidance/cg171. Accessed 10 Oct 2018.

Copyright information

© The International Urogynecological Association 2019

Authors and Affiliations

  1. 1.South Tees Hospitals NHS Foundation Trust, James Cook University HospitalMiddlesbroughUK
  2. 2.North Tees & Hartlepool NHS Foundation TrustStockton on TeesUK

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