Complications of transvaginal silicone-coated polyester synthetic mesh sling

Safety considerations for synthetic sling surgery

“…6 Furthermore, this study 6 excluded patients whose slings were removed owing to pain and other indications, thus the actual incidence of sling removal owing to complications is probably even higher than that. Extrapolating from this estimate and the estimated number of slings implanted in the 6,9,10,41,44,[100][101][102][103][104][105][106][107][108][109][110][111][112][113][114] Use of imperfect research methodologies, a lack of long-term follow up and reporting bias have been suggested as causes of these differences. 10,45,115,116 Safety and risk:benefit considerations Safety of SMUS surgery refers to the probability of any adverse event, while risk describes the range and probability of specific adverse events.…”

“…9 We have seen many unreported examples of patients managed conservatively with short-term success, who ultimately presented with a recurrent complication that occurred after the study ended, owing to the short follow-up duration of most published research (1-2 years) relative to the expected lifespan of most implanted slings. 9,81,105,[143][144][145][146][147] Authors of one study estimated the overall incidence of vaginal extrusion of mesh and pelvic pain to be 6% and 4.3%, respectively. 45 Despite peer-reviewed literature in this area being replete with statements about the short-lived nature of sling-related complications, most case reports of mesh sling complications document the treatment-refractory nature and suboptimal outcomes associated with these complications, none of which was captured by the original studies.…”

Editorial Comment to Bone‐anchored sling using the Mini Quick Anchor Plus and polypropylene mesh to treat post‐radical prostatectomy incontinence: Early experience

“…It has been hypothesized that a biofilm forms around the silicone-coated polyester, and that if infection occurs, antibiotics and host defenses cannot clear the infection, making sling explantation necessary. 4 It is likely that recurrent leakage in the Gynemesh group represents sling failure rather than bone anchor dislodgement or suture breakage. Persistent sling tension is necessary for the treatment of male stress incontinence, as evidenced by the substantially higher failure rate seen with resorbable allografts or xenografts compared with a permanent synthetic material that does not break down over time.…”

“…In the present study, the pad-free rate for Prolene Mesh patients was 50% (2/4 patients), comparable to InVance patients with reported padfree rates of 36-65% in patients with mild to severe stress urinary incontinence. 4,6,[8][9][10][11] Using Prolene Mesh for this operation thus appears useful.A key limitation of the present study was the use of only pad numbers to evaluate urinary incontinence. In the future, we intend to use both objective and subjective evaluations, such as the pad test and quality-of-life score.…”

“…In the present study, the pad-free rate for Prolene Mesh patients was 50% (2/4 patients), comparable to InVance patients with reported padfree rates of 36-65% in patients with mild to severe stress urinary incontinence. 4,6,[8][9][10][11] Using Prolene Mesh for this operation thus appears useful.…”