Vaginal Mesh Exposure After Single-Incision vs Full-Length Midurethral Sling Placement: A Retrospective Cohort Study

Midurethral slings (MUS) are the standard surgical treatment for stress urinary incontinence, but real-world data comparing vaginal mesh exposure risk across sling types are limited. We hypothesized that sling type, single-incision versus full-length, would be independently associated with vaginal mesh exposure and postoperative complications.

We conducted a retrospective cohort study of 369 women who underwent MUS placement by a single fellowship-trained Urogynecology and Reconstructive Pelvic Surgeon at a tertiary care institution from 2017 to 2023. Sling types included Altis® or Solyx™ (single-incision) and Advantage Fit™ or Obtryx™ II (full-length). The primary outcome was vaginal mesh exposure per IUGA/ICS criteria. Secondary outcomes included temporary urinary retention and bladder perforation. Time-to-event analysis used Kaplan-Meier curves and Cox regression, adjusting for sling type, menopausal status, and smoking history. Post hoc analysis confirmed 77% power for Altis® vs all other sling types.

Vaginal mesh exposure occurred in 28 patients (7.6%). Single-incision slings had higher exposure rates than full-length slings (12.6% vs 4.1%, HR 4.64, 95% CI 2.04-10.53, p < 0.001), with Altis® showing the highest risk (13.8% vs Advantage Fit™ 2.5%; HR 4.92, 95% CI 2.17-11.12, p < 0.001). Pre/perimenopausal status was also associated with elevated risk compared with postmenopausal status. Temporary urinary retention was less common with Altis® than with Advantage Fit™ (8.5% vs 19.1%). Bladder perforations occurred only with full-length slings (15 patients, 4.1%).

Single-incision slings, particularly Altis®, were associated with a higher mesh exposure risk than full-length slings. This device-specific risk difference may inform surgical planning and patient counseling.