Mesh Exposure After Mid-urethral Slings. A National Observational Study of 9 Years of Practice in Denmark

Stress urinary incontinence is a common condition that significantly affects women's quality of life. Minimally invasive mid-urethral slings are the gold standard treatment, offering high cure rates and low complication risks. Although rare, mesh exposure can cause debilitating pain, making prevention essential. Infection may contribute to mesh exposure, but evidence supporting prophylactic antibiotic use is limited. We hypothesized that a single perioperative dose of antibiotics reduces the risk of mesh exposure and that exposure rates differ between retropubic (R-MUS) and transobturator (tO-MUS) sling approaches.

We included Danish women undergoing primary mid-urethral sling surgery from 2010 to 2018 using nationwide registry data. Cox's regressions were used to assess the risk of mesh exposure by perioperative antibiotic use and sling type.

Among 6706 women, 3991 underwent R-MUS and 2715 tO-MUS, hereof 34 (0.9%) and 53 (2.0%), respectively, experienced mesh exposures; 5178 (77.2%) received perioperative antibiotics, 82% in the R-MUS and 70% in the tO-MUS group. Mesh exposure occurred in 30 (1.6%) patients with antibiotics vs. 23 (2.9%) without. Perioperative antibiotics reduced mesh exposure in the tO-MUS group (adjusted hazard ratio (aHR) 0.5 [95% confidence interval (CI) 0.3-0.9])), whereas the pooled R-MUS/tO-MUS analysis was nonsignificant (aHR 0.77 [95% CI 0.45-1.32]). In the R-MUS group, the effect remained inconclusive due to low precision. R-MUS was associated with a significantly lower risk of mesh exposure compared to tO-MUS (aHR 0.5 [95% CI 0.3-0.7]).

Perioperative antibiotics were linked to reduced mesh exposure after tO-MUS. R-MUS had a lower mesh exposure risk than tO-MUS.