Patient-Related Risk Factors for Mesh Erosion Following Midurethral Sling Procedures: A Systematic Review and...

Area of Science:

• Urology
• Gynecology
• Surgical Complications

Background:

• Midurethral slings (MUS) are a common surgical treatment for stress urinary incontinence (SUI).
• Mesh erosion is a significant complication associated with MUS procedures.
• Identifying patient-related risk factors is crucial for improving surgical outcomes.

Purpose of the Study:

• To systematically review and meta-analyze patient-related risk factors for mesh erosion following synthetic MUS procedures.
• To provide an evidence-based foundation for preoperative risk stratification and patient counseling.

Main Methods:

• Comprehensive literature search of MEDLINE, ScienceDirect, and Scopus (Jan 2010 - Mar 2025).
• Inclusion of studies reporting risk factors for mesh erosion after synthetic MUS for SUI.
• Quality assessment using Newcastle-Ottawa Scale and evidence certainty via GRADE approach.
• Fixed-effects meta-analyses to calculate pooled odds ratios (ORs) and 95% confidence intervals (CIs).

Main Results:

• Six high-quality studies (n=3068) were included, with mesh erosion prevalence ranging from 1.3% to 13.7%.
• Significant risk factors identified: prior pelvic surgery (OR 10.37), diabetes mellitus (OR 4.63), smoking (OR 3.38), obesity (BMI ≥ 30 kg/m²) (OR 2.79), and postmenopausal status (OR 2.34).
• Moderate-certainty evidence supports prior pelvic surgery, diabetes mellitus, smoking, and postmenopausal status as risk factors.

Conclusions:

• Prior pelvic surgery, postmenopausal status, diabetes mellitus, smoking, and obesity are significant risk factors for mesh erosion after MUS.
• These findings are essential for preoperative risk assessment and informed patient counseling.
• Further research may refine risk stratification and management strategies for SUI patients undergoing MUS.