Mesh Exposure After Midurethral Sling Procedures Confers a High Risk of Persistent Stress Urinary Incontinence [ID: 1373885]

INTRODUCTION: Stress urinary incontinence (SUI) affects between 4% and 35% of adult women. Midurethral slings (MUSs) are the gold standard for the treatment of SUI. Mesh exposure has been reported in 4.7–16.4% of patients who undergo MUS. It is unclear whether mesh exposure portends an increased risk of persistent SUI. The purpose of this study was to determine whether mesh exposure is associated with MUS failure/persistent SUI. METHODS: This was a retrospective cohort study from December 1, 2015 to January 1, 2022, of all patients who had a MUS procedure at a large community hospital. The primary outcome was persistent SUI at the 12-week postoperative appointment after MUS in patients with and without mesh exposure. RESULTS: A total of 456 patients underwent MUS procedure. The incidence of persistent SUI and mesh exposure was 6.4% and 8.8%, respectively. Twenty-five percent of patients with mesh exposure experienced persistent SUI, compared with 4.6% of patients without mesh exposure (P<.0001). In univariable analysis, mesh exposure and postmenopausal status were associated with persistent SUI while asthma was associated with mesh exposure. In logistic regression, persistent SUI was 6.5 times higher in patients with MUS mesh exposure compared to those without mesh exposure (adjusted odds ratio 6.46, 95% CI 2.71–15.44). CONCLUSION: Mesh exposure is an independent risk factor for persistent SUI. Patients with mesh exposure are approximately seven times more likely to experience persistent SUI compared to patients without mesh exposure. Currently, there is insufficient evidence to recommend surgical revision of MUSs complicated by mesh exposure, and further studies are warranted.