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Urethral Diverticulum following Polypropylene Mesh Midurethral Slings: A Literature Review
Elizabeth Pacer1, Omar Felipe Duenas-Garcia1, Lekha Hota1
1Department of Obstetrics & Gynecology, West Virginia University School of Medicine, Morgantown, WV 26506, USA.
Aims:
It is currently unknown whether an association exists between polypropylene mesh and urethral diverticulum formation following placement of polypropylene midurethral slings (MUS) for the treatment of stress urinary incontinence (SUI). We aimed to examine the literature associating MUS with the occurrence of urethral diverticula.
Methods:
Multiple online research databases, including PubMed, Google Scholar, EBSCOhost, and the Cochrane Library, were searched, from January 2019 to February 2019, for evidence related to the occurrence of urethral diverticula following polypropylene MUS procedures.
Results:
Four case reports were published demonstrating the occurrence of urethral diverticula following the use of polypropylene mesh for surgical treatment of SUI. Subjects of these cases were menopausal and had an elevated body mass index (BMI), recurrent urinary tract infections (UTIs), autoimmune conditions, or prior pelvic floor surgeries. A thorough urologic workup, including imaging prior to sling placement, was not always performed.
Conclusion:
No clear association exists between polypropylene MUS placement and subsequent urethral diverticulum formation. Factors that diminish polypropylene mesh biocompatibility include elevated BMI, menopause, recurrent UTIs, prior pelvic surgeries, and preexisting medical conditions. Symptoms associated with urethral diverticula should prompt a complete urologic workup prior to MUS placement.
Insights
No clear link exists between polypropylene midurethral slings (MUS) and urethral diverticulum formation. Patient factors like high BMI and prior surgeries may affect mesh biocompatibility, necessitating thorough urologic workup before MUS placement.
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.
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