Post-operative urinary retention and urinary tract infections predict mid-urethral sling mesh complications

Objective — To determine if post-operative urinary retention and urinary tract infections (UTI) were predictors of future mesh complications requiring surgical intervention after midurethral sling (MUS).

Methods — Administrative data in Ontario, Canada between 2002 and 2013 was used to identify all women who underwent a mesh-based MUS. The primary outcome was revision of the transvaginal mesh sling (including mesh erosion/removal, fistula or urethrolysis). Two potential risk factors were analyzed: post-operative retention (within 30 days of procedure) and number of post-operative emergency room visits or hospital admissions for UTI symptoms.

Results — A total of 59,556 women had a MUS, of which 1,598 (2.7%) required revision surgery. Of the 2,025 women who presented to the emergency room or were admitted to hospital for post-operative retention, 212 (10.5%) required operative mesh revision. Of the 11,747 patients who had at least one post-operative UTI, 366 (3.1%) patients required operative mesh revision. In adjusted analysis, post-operative retention was significantly predictive of future reoperation (HR 3.46, 95%CI 2.97-4.02), and this difference persisted when urethrolysis was excluded as a reason for sling revision (HR 3.08, 95% CI 2.62-3.63). Similarly, in adjusted analysis, each additional post-operative hospital visit for UTI symptoms increased the risk for surgical intervention for mesh complications (HR 1.74 95% CI 1.61-1.87).

Conclusions — Post-operative urinary retention and hospital presentation for UTI symptoms are associated with an increased risk of reoperation for MUS complications. These patients should be followed and investigated for mesh complications when appropriate.