Pain after midurethral sling; the underestimated role of mesh removal

Abstract

Introduction The primary aim of this study was to evaluate the results of midurethral sling (MUS) removal in women who have pain as their single complication of MUS. Material and methods We performed a retrospective chart study supplemented with a cross sectional questionnaire. Women who underwent MUS removal for pain as the solitary reason for removal between 2004 and 2018 were included. Primary outcome was change in pain levels assessed by the visual analogue scale (VAS) pain score (range 0–10). Secondary outcome was the recurrence of stress urinary incontinence (SUI). Results Twenty-six of 31 patients returned the questionnaire. Median medical file follow-up was 12 months (range 2–66) and 25 months (range 5–104) regarding questionnaires. VAS pain score dropped from 7.8 (SD 1.9) at baseline to 4.5 (SD 3.2) at follow-up (p <.00). Seven (23%) patients were pain-free. Patients undergoing partial vaginal resection (n = 6) had a VAS pain score decrease of 4.7 (p = .02) versus 2.7 (p = .02) for complete vaginal removal (n = 14). Twenty-three (89%) patients experienced SUI at follow-up, whereof 10 (45%) reported (almost) no incidents of SUI. Conclusions MUS removal is a viable and safe option with a significant drop in VAS pain score in patients with chronic pain after MUS placement. A post-operative increase of SUI and a possible renewed wish for SUI treatment have to be considered. This should not be a reason to refrain from information and/or referral for surgical removal.

Mesh Extraction Surgery and Laser Treatment for Pain After Mid-Urethral Sling Surgery: A Case Series

“…Stress urinary incontinence (SUI) is the leakage of urine triggered by actions, such as coughing or sneezing, affecting about one in three women aged 18 and older, greatly impacting their quality of life (QOL) [1][2][3][4][5]. First-line surgical treatment involves the insertion of a mid-urethral sling (MUS) [1][2][3][4][5]. There are three types of MUS: tension-free vaginal tape (TVT), transobturator tape (TOT), and a mid-urethral tissue fixation system (TFS).…”

“…Another treatment modality consists of fascial sling surgery where fascia is inserted instead of a mesh. MUS has a reported high patient satisfaction but a complication rate of 2.7-9.8% over five years [4]. Treatment for complications includes MUS removal (implementation rate: about 3%) and reinsertion surgery (implementation rate: 2.7-7.8%); however, relative to the complication rate, the percentage of individuals that undergo MUS removal is small [4].…”

“…MUS has a reported high patient satisfaction but a complication rate of 2.7-9.8% over five years [4]. Treatment for complications includes MUS removal (implementation rate: about 3%) and reinsertion surgery (implementation rate: 2.7-7.8%); however, relative to the complication rate, the percentage of individuals that undergo MUS removal is small [4]. Among the complications, pain associated with the mesh can have a significant impact on subsequent QOL [1][2][3][4][5][6], accounting for 1-17% of MUS extractions [1][2][3][4][5][6].…”

“…The main indications for mesh extraction are pain, urethral obstruction, vaginal epithelial erosion, and dyspareunia. However, pain after MUS surgery is difficult to manage with conservative treatments, except for well-defined causes, such as erosion and exposure [4][5][6]. Conservative treatments include pelvic floor muscle exercises, oral anti-inflammatory analgesics, and local anesthesia with analgesics and anesthetics.…”

“…Subsequently, when conservative treatments fail, MUS removal is expected to have a certain degree of success; however, there are few studies on mesh extraction [5]. Existing studies suggest that mesh extractions are underestimated [4][5][6]. This may be primarily due to some physicians or patients believing that mesh removal will cause SUI recurrence or other side effects.…”