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130 - RISK FACTORS FOR POLYPROPYLENE MIDURETHRAL SLING EXTRUSION: A CASE-CONTROL STUDY

130

RISK FACTORS FOR POLYPROPYLENEMIDURETHRAL SLING EXTRUSION: A CASE-CONTROL STUDY

D. SANDERSON1, S.MALCZEWSKI 2, R. SANDERSON 3, A. EDDIB 2;
1Millard Fillmore Suburban Hosp., Williamsville, NY,2Western New York Urology Associates, Cheektowaga, NY,3Brescia Univ., Owensboro, KY.

Introduction: Syntheticmidurethral sling (MUS) is the most common anti-incontinenceprocedure performed in the United States (1, 2). Although rare,vaginal mesh extrusion is the most commonly identified indication forpost-operative surgical revision (2, 3). Unfortunately, currentliterature on risk factors for vaginal mesh extrusion is limited dueto incidence, current clinical practice, and study design.
Objective:The objective of this study is to identify and describe risk factorsassociated with surgical revision of polypropylene MUS for meshextrusion, in hopes of adding to the currently availabledata.
Methods: This is a case-control study from 2001 -2016. We identified women who had primary surgical revision ofsynthetic MUS due to vaginal mesh extrusion and compared them tocases without post-operative mesh extrusion, in a 1:6 ratio. Patientdemographics and clinical characteristics was collected from both theclinical and hospital associated electronic medical records (EMR) andwere compared using a 2-sample comparison of proportions.Multivariate logistic regression modeling was performed to analyzethe relationships between statistically significant (p < .20)clinical risk factors and vaginal mesh extrusion.
Results:In total, 64 patients underwent primary sling revision due to meshextrusion during the study period. The average age at time ofsurgical correction was 51.7 years (range, 30 - 78) with a mean BMIof 27.9 (range, 23.6 - 30.2). The median time to revision was 318days (interquartile range, 144.25 - 1355 days). Revision for meshextrusion was more likely in patients under 55 years (OR = 2.45, [95%CI = 1.32 - 4.54]), were current smokers (OR = 2.88, [95% CI = 1.51 -5.50]), had a BMI < 30 (OR = 4.83, [95% CI= 2.19 - 10.63]), andwho had retropubic sling (OR = 1.53, [95% CI = 0.81 -2.91]).
Conclusions: Current smoking status, an age of lessthan 55 years, a BMI under 30, and retropubic approach weresignificant risk factors for surgical revision due to vaginal meshextrusion following placement of synthetic midurethral sling. Thesefindings are additive to the currently available data (2,3) and mayimprove preoperative patient counseling and intervention.
References:

  1. Geller EJ,Wu JM. Changing trends in surgery for stress urinary incontinence.Curr Opin Obstet Gynecol. 2013 Oct;25(5):404-9.

  2. JonssonFunk M, Siddiqui NY, Pate V, Amundsen CL, Wu, JM. Slingrevision/removal for mesh erosion and urinary retention: long-termrisk and predictors. Am J Obstet Gynecol. 2013 Jan;208(1):73.e1-7.

  3. Linder BJ,El-Nashar SA, Carranza Leon DA, Trabuco EC. Predictors of vaginalmesh exposure after midurethral sling placement: a case-controlstudy. Int Urogynecol J. 2016 Sep;27(9):1321-6.