Urethral Diverticulum following Polypropylene Mesh Midurethral Slings: A Literature Review

Area of Science:

• Urology
• Female Pelvic Medicine
• Mesh Surgery

Background:

• Stress urinary incontinence (SUI) is often treated with midurethral slings (MUS).
• Polypropylene mesh is a common material used in MUS procedures.
• The potential for MUS to cause urethral diverticula is not well-established.

Purpose of the Study:

• To investigate the association between polypropylene MUS and urethral diverticulum formation.
• To review existing literature on this specific complication of MUS surgery.

Main Methods:

• A comprehensive literature search was conducted across major online databases (PubMed, Google Scholar, EBSCOhost, Cochrane Library).
• The search focused on evidence published between January 2019 and February 2019.
• Case reports detailing urethral diverticula following polypropylene MUS were analyzed.

Main Results:

• Four case reports identified urethral diverticula after polypropylene MUS implantation.
• Associated patient factors included menopause, elevated BMI, recurrent UTIs, autoimmune conditions, and prior pelvic surgeries.
• Inadequate pre-sling urologic workup was noted in some cases.

Conclusions:

• The current literature does not establish a definitive causal link between polypropylene MUS and urethral diverticula.
• Factors such as elevated BMI, menopause, recurrent UTIs, and prior surgeries may compromise mesh biocompatibility.
• Comprehensive urologic evaluation is recommended before MUS placement, especially if diverticulum symptoms are present.