No Correlation Between Presenting Symptoms Prior to Suburethral Sling Removal and Explanted Pathology Findings Suggests No Need for Routine Microscopic Pathology Evaluation.

Abstract

We compared explanted midurethral sling (MUS) standard clinical pathology report findings with presenting symptoms before synthetic sling removal (SSR). An institutional review board-approved, prospectively maintained database of women who underwent a single SSR for MUS-related complication(s) was retrospectively reviewed for demographics, time interval between MUS placement and SSR, MUS type, and presenting symptoms before SSR. We compared 2 groups, one with MUS-related symptoms, including incontinence, voiding dysfunction, dyspareunia/pain, erosion, exposure, and/or urinary tract infections, and the second group characterized by self-reported symptoms attributed to the mesh material (systemic, autoimmune, or inflammatory disorder-mesh reaction group). From 2005 to 2019, 332 of 473 women met study criteria, with 24 reporting mesh reaction-related symptoms. There was no difference in microscopic pathology findings between the 2 groups. In the mesh-related group, women were younger (P = 0.041) and had more pain/dyspareunia as their primary SSR indication (P = 0.002). That group was also significantly more likely to have a preexisting diagnosis of fibromyalgia (P < 0.001) and established autoimmune disorder (P = 0.033). No significant correlation between presenting findings and sling pathology was observed. No correlation was observed when comparing pathological findings of explanted MUS with presenting symptoms of MUS-related complications, including in women with mesh reaction-related concerns.