Analysis of risk factors associated with vaginal erosion after synthetic sling procedures for stress urinary incontinence

Abstract

The goal of this study was to analyze the risk factors associated with vaginal erosion after synthetic sling procedure for stress urinary incontinence. Follow-up evaluations were at 1 week, 1 to 3 months, 6 months, and annually after the operation. The evaluations included detailed history taking, vaginal examinations, and perineal ultrasonographic urethrocystography. The vaginal erosion rate (6/239) after the synthetic sling procedure was 2.5%. We assessed the relationship between clinical features and vaginal erosion. Of these, only diabetes mellitus (DM) was a significant risk factor for vaginal erosion. Women with DM were 8.3 times more at risk than women without DM for developing vaginal erosion after synthetic sling procedure (p < 0.05). The vaginal erosion-free rate during the 24-month follow-up decreased significantly in women with DM. The rate of vaginal erosion associated with type III multifilamentous polypropylene sling (intravaginal slingplasty) is 10.7% more than that with type I monofilament polypropylene sling (such as tension-free vaginal tape and inside out transobturator vaginal tape) (p = 0.054). Women with DM should be informed that vaginal erosion is a possible complication after synthetic sling procedure.

To evaluate the safety and efficacy of the TVT-Secur procedure in the treatment of stress urinary incontinence in women

“…Besides the type of tape with the biomaterial used, exposures have been found to be higher in diabetics as in the study by Chen et al 15 The cause of erosion can be possibly attributed to the presence of NIDDM in one patient. Although the polypropylene used in the tape is Type 1 macroporous monofilamentous mesh with pore size of greater than 75 microns, the cause in the second patient could not be pinpointed.…”

“…Although the polypropylene used in the tape is Type 1 macroporous monofilamentous mesh with pore size of greater than 75 microns, the cause in the second patient could not be pinpointed. Plication of the pubocervical fascia between the urethral mucosa and the tape, as proposed by Chen et al 15 and Sivaslioglu et al, 16 has been considered as a possible measure to reduce the incidence of erosions.…”

Delayed vaginal and urethral mesh exposure: 10 years after TVT surgery

“…Biomechanical properties of the graft materials may be associated with mesh exposure. Risk factors associated with exposure are diabetes mellitus (DM), (women with DM are 8.3 times more at risk than women without DM [4]), concomitant procedures (vaginal hysterectomy, genital prolapse surgery), previous incontinence surgery, and nonestrogenic state. Presumptive risk factors for urethral mesh exposure include urethral dilatation, sling misplacement, excessive tensioning, and local tissue infection [1].…”

“…Presumptive risk factors for urethral mesh exposure include urethral dilatation, sling misplacement, excessive tensioning, and local tissue infection [1]. Symptoms include vaginal discharge or bleeding, vaginal pain, suprapubic pain, recurrent urinary tract infection, hematuria, urinary incontinence, and perineal or urethral pain syndrome [1,4]. However, some patients are asymptomatic, and therefore, vaginal examination plays an important role in detecting mesh exposure.…”

The multifilament polypropylene tape erosion trouble: tape structure vs surgical technique. Which one is the cause?

“…Local factors include scarring, markedly atrophic vaginal wall, and estrogen deficiency [16]. Systemic factors include diabetes mellitus [19]. Iatrogenic causes include postoperative urinary retention, postoperative traumatic catheterization, or urethral dilatation [20].…”