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Adverse events after first, single, mesh and non-mesh surgical procedures for stress urinary incontinence and pelvic organ prolapse in Scotland, 1997–2016: a population-based cohort study

Morling, Joanne R.; McAllister, David A.; Agur, Wael; Fischbacher, Colin M.; Glazener, Cathryn M.A.; Guerrero, Karen; Hopkins, Leanne; Wood, Rachael

Authors

JOANNE MORLING JOANNE.MORLING@NOTTINGHAM.AC.UK
Clinical Associate Professor

David A. McAllister

Wael Agur

Colin M. Fischbacher

Cathryn M.A. Glazener

Karen Guerrero

Leanne Hopkins

Rachael Wood



Abstract

Background

Concerns have been raised about the safety of surgery for stress urinary incontinence and pelvic organ prolapse using transvaginal mesh. We assessed adverse outcomes after first, single mesh procedures and comparable non-mesh procedures.

Methods

We did a cohort study of women in Scotland aged 20 years or older undergoing a first, single incontinence procedure or prolapse procedure during 1997–98 to 2015–16 identified from a national hospital admission database. Primary outcomes were immediate postoperative complications and subsequent (within 5 years) readmissions for later postoperative complications, further incontinence surgery, or further prolapse surgery. Poisson regression models were used to compare outcomes after procedures carried out with and without mesh.

Findings

Between April 1, 1997, and March 31, 2016, 16 660 women underwent a first, single incontinence procedure, 13 133 (79%) of which used mesh. Compared with non-mesh open surgery (colposuspension), mesh procedures had a lower risk of immediate complications (adjusted relative risk [aRR] 0·44 [95% CI 0·36–0·55]) and subsequent prolapse surgery (adjusted incidence rate ratio [aIRR] 0·30 [0·24–0·39]), and a similar risk of further incontinence surgery (0·90 [0·73–1·11]) and later complications (1·12 [0·98–1·27]); all ratios are for retropubic mesh. During the same time period, 18 986 women underwent a first, single prolapse procedure, 1279 (7%) of which used mesh. Compared with non-mesh repair, mesh repair of anterior compartment prolapse was associated with a similar risk of immediate complications (aRR 0·93 [95% CI 0·49–1·79]); an increased risk of further incontinence (aIRR 3·20 [2·06–4·96]) and prolapse surgery (1·69 [1·29–2·20]); and a substantially increased risk of later complications (3·15 [2·46–4·04]). Compared with non-mesh repair, mesh repair of posterior compartment prolapse was associated with a similarly increased risk of repeat prolapse surgery and later complications. No difference in any outcome was observed between vaginal and, separately, abdominal mesh repair of vaginal vault prolapse compared with vaginal non-mesh repair.

Interpretation

Our results support the use of mesh procedures for incontinence, although further research on longer term outcomes would be beneficial. Mesh procedures for anterior and posterior compartment prolapse cannot be recommended for primary prolapse repair. Both vaginal and abdominal mesh procedures for vaginal vault prolapse repair are associated with similar effectiveness and complication rates to non-mesh vaginal repair. These results therefore do not clearly favour any particular vault repair procedure.

Citation

Morling, J. R., McAllister, D. A., Agur, W., Fischbacher, C. M., Glazener, C. M., Guerrero, K., …Wood, R. (2017). Adverse events after first, single, mesh and non-mesh surgical procedures for stress urinary incontinence and pelvic organ prolapse in Scotland, 1997–2016: a population-based cohort study. Lancet, 389(10069), 629-640. https://doi.org/10.1016/S0140-6736%2816%2932572-7

Journal Article Type Article
Acceptance Date Oct 14, 2016
Online Publication Date Dec 20, 2016
Publication Date Feb 11, 2017
Deposit Date Dec 21, 2016
Publicly Available Date Mar 29, 2024
Journal The Lancet
Print ISSN 0140-6736
Electronic ISSN 1474-547X
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 389
Issue 10069
Pages 629-640
DOI https://doi.org/10.1016/S0140-6736%2816%2932572-7
Public URL https://nottingham-repository.worktribe.com/output/846353
Publisher URL http://www.sciencedirect.com/science/article/pii/S0140673616325727?via%3Dihub
Additional Information © 2016 Elsevier Limited

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