Long-Term Safety with Sling Mesh Implants for Stress Incontinence

被引:12
作者
Chughtai, Bilal [1 ]
Mao, Jialin [2 ]
Matheny, Michael E. [2 ,3 ,4 ]
Mauer, Elizabeth [2 ]
Banerjee, Samprit [2 ]
Sedrakyan, Art [2 ]
机构
[1] Weill Cornell Med Coll New York Presbyterian, Dept Urol, New York, NY USA
[2] Weill Cornell Med Coll New York Presbyterian, Dept Healthcare Policy & Res, New York, NY USA
[3] Vanderbilt Univ, Med Ctr, Dept Biomed Informat, Nashville, TN USA
[4] Tennessee Valley Healthcare Syst VA, Geriatr Res Educ & Clin Care GRECC Serv, Nashville, TN USA
关键词
suburethral slings; urinary incontinence; stress; surgical mesh; treatment outcome; PELVIC ORGAN PROLAPSE; URINARY-INCONTINENCE; RISK; DEPRESSION; SURGERY;
D O I
10.1097/JU.0000000000001312
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Purpose: We examined long-term risks and predictors of mesh erosion and reoperation following mid urethral sling procedure for stress urinary incontinence. Materials and Methods: Women aged 18 years or older who received a mid urethral sling for stress urinary incontinence between 2008 and 2016 in outpatient surgical settings in New York State were included in our study. Those who underwent concomitant mesh pelvic organ prolapse repair were excluded. Primary outcomes were post-implantation time to erosion and reoperations. Kaplan-Meier analysis and Cox proportional hazard models were used to assess the risks of erosion diagnosis and reoperation. Results: Our cohort included 36,195 women with a mean +/- SD age of 53.7 +/- 12.4 years. Estimated risks of erosions and reoperations at 7 years after sling procedures were 3.7% and 6.7%, respectively. Older age (>= 65 vs <65: HR 0.83, 95% CI 0.70-0.99) and high volume facilities (high vs low: HR 0.79, 95% CI 0.68-0.92) were associated with a lower risk of erosion. History of hysterectomy was associated with a higher risk of erosion (HR 1.62, 95% CI 1.36-1.92). Predictors of reoperation included concurrent abdominal or native tissue transvaginal prolapse repair, previous hysterectomy and depression. Conclusions: One in 27 women had sling erosions and 1 in 15 had invasive reoperations at 7 years after sling procedures. The highest erosion cases were observed among younger White women treated at low volume facilities. Continued and vigilant surveillance of mesh in stress urinary incontinence repairs, the nature and burden of stress urinary incontinence recurrence, different types of re-treatment, patient reported outcomes and information about treating surgeons are crucial.
引用
收藏
页码:183 / 190
页数:8
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