Related Experiment Video
Updated: Oct 7, 2025
A Novel Surgical Technique in a Sheep Model for Suburethral Graft Implantation
Published on: June 20, 2025
Surgical Removal of Midurethral Sling in Women Undergoing Surgery for Presumed Mesh-Related Complications: A
Paula Jaye Doyle1, Cara L Grimes, Ethan M Balk
1Departments of Obstetrics and Gynecology and Urology, University of Rochester School of Medicine and Dentistry, Rochester, New York; the Departments of Obstetrics and Gynecology and Urology, New York Medical College, Valhalla, New York; the Center for Evidence Synthesis in Health, Brown School of Public Health, Brown University, Providence, Rhode Island; the Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, California; the Department of Obstetrics and Gynecology, Harvard Medical School, Boston, Massachussetts; the Department of Obstetrics and Gynecology, Albert Einstein College of Medicine, New York, New York; International Medical Response, Brooklyn, New York; the Department of Obstetrics and Gynecology, University of Texas Health Science Center San Antonio, San Antonio, Texas; Bela Vida Urogynecology, Celebration, Florida; the Department of Obstetrics and Gynecology, the Permanente Medical Group, Roseville, California; the Department of Obstetrics and Gynecology, Medical College of Wisconsin, Waukesha, Wisconsin; the Department of Obstetrics and Gynecology, Cooper Medical School of Rowan University, Camden, New Jersey; the Department of Obstetrics and Gynecology, HCA/UCF Consortium, Gainesville, Florida; and the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics & Gynecology, University of New Mexico, Albuquerque, New Mexico.
Objective:
To assess whether some, or all, of the mesh needs to be removed when a midurethral sling is removed for complications.
Data Sources:
A systematic review and meta-analysis was conducted. MEDLINE, Cochrane, and ClinicalTrials.gov databases from January 1, 1996, through May 1, 2021, were searched for articles that met the eligibility criteria with total, partial, or a combination of anti-incontinence mesh removal.
Methods Of Study Selection:
All study designs were included (N≥10), and a priori criteria were used for acceptance standards. Studies were extracted for demographics, operative outcomes, and adverse events. Meta-analysis was performed when possible.
Tabulation, Integration, And Results:
We double-screened 11,887 abstracts; 45 eligible and unique studies were identified. Thirty-five were single-group studies that evaluated partial mesh removal, five were single-group studies that evaluated total mesh removal, and five were studies that compared partial mesh removal with total mesh removal. All of the studies were retrospective in nature; there were no randomized controlled studies. Comparative studies demonstrated that partial mesh removal had lower rates of postoperative stress urinary incontinence (SUI) than total mesh removal (odds ratio 0.46, 95% CI 0.22-0.96). Single-group studies supported lower rates of postoperative SUI with partial mesh removal compared with total mesh removal (19.2% [95% CI 13.5-25.7] vs 48.7% [95% CI 31.2-66.4]). Both methods were similar with respect to associated pain, bladder outlet obstruction, mesh erosion or exposure, and lower urinary tract symptoms. Adverse events were infrequent.
Conclusion:
Postoperative SUI may be lower with partial mesh removal compared with total mesh removal. Other outcomes were similar regardless of the amount of mesh removed.
Systematic Review Registration:
PROSPERO, CRD 42018093099.
Insights
Partial mesh removal may lead to lower rates of postoperative stress urinary incontinence (SUI) after midurethral sling removal. Other outcomes, including pain and complications, were similar regardless of the amount of mesh removed.
Area of Science:
- Urology
- Gynecologic Surgery
- Medical Device Research
Background:
- Midurethral slings are used to treat stress urinary incontinence (SUI).
- Complications can arise from midurethral slings, necessitating mesh removal.
- The extent of mesh removal (partial vs. total) for complications is debated.
Purpose of the Study:
- To systematically review and meta-analyze the outcomes of partial versus total mesh removal for midurethral sling complications.
- To compare the efficacy and safety of different mesh removal strategies.
Main Methods:
- Systematic review and meta-analysis of studies from MEDLINE, Cochrane, and ClinicalTrials.gov (1996-2021).
- Inclusion of all study designs (N≥10) evaluating partial, total, or combined anti-incontinence mesh removal.
- Extraction of data on demographics, operative outcomes, and adverse events; meta-analysis performed where possible.
Main Results:
- 45 unique studies were identified, primarily retrospective.
- Comparative studies showed lower postoperative SUI rates with partial mesh removal (OR 0.46) versus total removal.
- Single-group studies also supported lower SUI rates with partial removal (19.2%) compared to total removal (48.7%).
- Pain, bladder outlet obstruction, mesh erosion, and lower urinary tract symptoms were similar between partial and total removal groups.
- Adverse events were infrequent.
Conclusions:
- Partial mesh removal may result in lower rates of postoperative stress urinary incontinence compared to total mesh removal.
- Outcomes such as pain, obstruction, and erosion are comparable regardless of the extent of mesh removal.
- The decision for partial or total mesh removal should consider the potential impact on SUI rates.
