One in 30 Ontario women require vaginal mesh revision or removal surgery after treatment for stress urinary incontinence

Vaginal mesh slings have become the most common surgical treatment for female stress incontinence during the past 20 years. However, according to a new study by researchers at the Institute for Clinical Evaluative Sciences (ICES) Ontario women have a one in 30 chance of mesh removal or revision after treatment, and a nearly five-fold increased risk of complications with multiple mesh slings.

Women with stress urinary incontinence leak urine when they cough, sneeze, laugh or are physically active. Mesh slings are made of a polypropylene material that is surgically implanted in the vaginal wall to treat this urinary leakage.

The study published today in JAMA Surgery is the first to measure the rate of mesh removal or revision required among Canadian women.

“Our study shows that after 10 years of follow-up, one in 30 Ontario women required mesh revision or removal surgery,” said Dr. Blayne Welk, senior author of the study and adjunct scientist at ICES Western. “In addition, we found that it is very common to place additional mesh incontinence slings if the initial one does not work or fails, however this practice increases the risk of eventual mesh removal or revision by almost five-fold.”

There is known risk of complications such as vaginal or leg pain, mesh erosion or exposure, or trouble voiding after placement of vaginal mesh. These complications can be challenging to treat, and often require surgery to repair. Health Canada and the FDA have acknowledged these risks. The majority of this risk has been attributed to vaginal mesh used for prolapse surgery; however stress incontinence mesh can cause these complications as well.

The study looked at all adult women in Ontario who underwent a stress urinary incontinence procedure with synthetic mesh from 2002 through 2012.

“We also found that surgeon experience was important, patients of surgeons who did the most mesh incontinence surgeries had a 27 per cent lower chance of needing mesh removal or revision,” added Welk, also a urologist at St. Joseph’s Hospital in London.

The researchers add that these findings support the regulatory statements that suggest patients should be counseled that serious complications can occur with mesh based stress urinary incontinence procedures, and that providers should achieve expertise in their chosen procedure.

“Removal or revision of vaginal mesh used for the treatment of stress urinary incontinence,” was published today in JAMA Surgery.

Author block: Blayne Welk, Hana’a Al-Hothi and Jennifer Winick-Ng.

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy.

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