Mid‐urethral sling revision for mesh exposure–long‐term outcomes of two surgical techniques from a comparative clinical retrospective cohort study

Objective To compare vaginal closure with versus without sling excision in the management of vaginal sling exposure following mid‐urethral sling (MUS). Design Clinical retrospective cohort study. Setting Tertiary urogynaecological centre in Australia. Population Women with urodynamic stress urinary incontinence (SUI) who had a MUS ( n = 2823) during 1999–2017 with a follow‐up period up to December 2018. Thirty‐three women (1%) had sling exposure and 31 required surgical intervention (1%). Methods Clinical review with analysis of surgical database and patient records. Main outcome measures The primary outcome was successful closure and resolution of exposure‐related symptoms without the need for re‐surgery. Secondary outcomes were repeat procedure and recurrent incontinence following revision. Results Mean follow up was 103 months. Of the 20 women with a primary excision and closure approach, 19 had successful closure. Seven of 11 women with simple vaginal closure without excision needed another surgery for recurrent mesh exposure. Recurrence of stress incontinence did not occur in any of the four who had ‘successful’ closure without excision. Of those who had sling division/removal without a concomitant stress continence procedure, 32% (7/22) required further surgery. Conclusion Sling excision and repair have better outcomes with less recurrence of sling exposure compared with simple closure. Following sling removal, one of three women will develop SUI recurrence and require surgery. Tweetable abstract #Slingexcision &repair leads to less recurrence of exposure versus #simpleclosure for #slingmeshexposure.