Do we have adequate data to construct a valid algorithm for management of synthetic midurethral sling complications? ICI‐RS 2019

Abstract

Background Synthetic midurethral sling (MUS) procedures, purported for the last two decades as the gold standard surgical treatment for stress urinary incontinence, have been in creasingly scrutinized in recent years with regard to the rate and severity of complications. Methods During the International Consultation on Incontinence Research Society meeting held in Bristol, UK, in 2019, a multidisciplinary panel held a think tank and discussed the contemporary evidence pertaining to the classification, investigation, and treatment of MUS complications. Results The current classification system of mesh‐related complications was discussed, and shortcomings were identified. The lack of a standardized clinical pathway was noted, and the value of clinical investigations and surgical treatments was difficult to fully evaluate. The paucity of high‐level evidence was a common factor in all discussions, and the difficulties with setting up relevant randomized‐controlled trials were highlighted. Conclusions The outcome of the think‐tank discussions is summarized with a set of recommendations designed to stimulate future research.

Complications of synthetic mesh inserted for stress urinary incontinence

“…Not all these investigations may be required and should be individually tailored to the patient, e.g. EUA may be useful in cases where women have significant pain that precludes performing a satisfactory pelvic examination in the clinic [6]. Imaging is an important modality for investigating mesh complications and includes ultrasonography (US; translabial, transperineal or transvaginal) or pelvic MRI.…”