Abstract
ObjectiveTo compare the incidence of systemic conditions between women who had surgical treatment for stress incontinence with mesh and without mesh.DesignNational cohort study.SettingEnglish National Health Service.PopulationWomen with no previous record of systemic disease who had first‐time urinary incontinence surgery between 1 January 2006 and 31 December 2013, followed up to the earliest of 10 years or 31 March 2019.MethodsCompeting‐risks regression was used to estimate hazard ratios (HR), adjusted for patient characteristics, with HR > 1 indicating increased incidence following mesh surgery.Main outcome measuresFirst postoperative admission with a record of autoimmune disease, fibromyalgia or myalgic encephalomyelitis up to 10 years following the first incontinence procedure.ResultsThe cohort included 88 947 women who had mesh surgery and 3389 women who had non‐mesh surgery. Both treatment groups were similar with respect to age, socio‐economic deprivation, comorbidity and ethnicity. The 10‐year cumulative incidence of autoimmune disease, fibromyalgia or myalgic encephalomyelitis was 8.1% (95% CI 7.9–8.3%) in the mesh group and 9.0% (95% CI 8.0–10.1%) in the non‐mesh group (adjusted HR 0.89, 95% CI 0.79–1.01; P = 0.07). A sensitivity analysis including only autoimmune diseases as an outcome returned a similar result.ConclusionsThese findings do not support claims that synthetic mesh slings cause systemic disease.Tweetable abstractNo evidence of increased risk of systemic conditions after stress incontinence treatment with a mesh sling.
Highlights
Stress urinary incontinence is a common condition affecting up to 40% of postmenopausal women that can have a significant effect on quality of life.[1,2] Conservative treatment options include lifestyle interventions and pelvic floor muscle training.[3]
The 10-year cumulative incidence of autoimmune disease, fibromyalgia or myalgic encephalomyelitis was 8.1% in the mesh group and 9.0% in the non-mesh group
Tweetable abstract No evidence of increased risk of systemic conditions after stress incontinence treatment with a mesh sling
Summary
Stress urinary incontinence is a common condition affecting up to 40% of postmenopausal women that can have a significant effect on quality of life.[1,2] Conservative treatment options include lifestyle interventions and pelvic floor muscle training.[3] Further treatments include various surgical options, such as colposuspension, where sutures are used to elevate the proximal urethra, or a mid-urethral sling insertion.[4] Slings can be made from a length of fascia harvested from the patient (‘non-mesh’ sling), or from synthetic material (‘mesh’ sling). Mesh slings were introduced in the 1990s. A randomised controlled trial with a followup period of 6 months, published in 2002, found a 2021 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd
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