Risk Factors for Polypropylene Midurethral Sling Extrusion: A Case-Control Study

Area of Science:

• Urogynecology
• Pelvic Reconstructive Surgery
• Biomaterials in Medicine

Background:

• Midurethral slings (MUS) are commonly used for stress urinary incontinence.
• Mesh extrusion is a known complication requiring surgical intervention.
• Identifying risk factors for MUS revision is crucial for improving patient outcomes.

Purpose of the Study:

• To identify risk factors associated with surgical revision of midurethral slings (MUS) due to vaginal mesh extrusion.
• To analyze patient demographics and clinical characteristics linked to MUS revision.

Main Methods:

• A case-control study was conducted comparing women who underwent primary surgical revision for polypropylene MUS mesh extrusion (cases) with a control group.
• Data from 2001-2016 were analyzed, including patient demographics and clinical factors.
• Multivariate logistic regression was used to determine the association between risk factors and mesh extrusion.

Main Results:

• The study identified 64 cases and 400 controls.
• Significant risk factors for MUS revision included current smoking (OR=5.43), BMI under 30 kg/m² (OR=4.37), age under 55 years (OR=2.02), retropubic sling placement (OR=2.10), and fibromyalgia (OR=3.33).
• The median time to MUS revision was 318 days.

Conclusions:

• Smoking, younger age, lower BMI, fibromyalgia, and retropubic sling approach are associated with midurethral sling revision due to mesh extrusion.
• These identified factors can enhance patient counseling and selection for MUS procedures.
• Further research may focus on preventative strategies for high-risk individuals.