Recurrent Urinary Tract Infections in the Setting of Mesh Implants

Abstract

Mid-urethral polypropylene mesh slings are widely accepted as a standard for surgical management of stress urinary incontinence due to a low complication rate and superior efficacy. Synthetic mesh implants used to augment female pelvic prolapse repairs gained popularity following introduction of these slings. Mesh implants for prolapse have been under increased scrutiny after the FDA safety notification was published in 2008 due to a higher than anticipated complication rate. While the complication rate of mesh slings used for incontinence is low, both incontinence mesh and prolapse mesh are associated with similar types of complications. These include mesh exposure, pain, voiding dysfunction, and infections. The majority of available literature describes the incidence of acute urinary tract infections in the immediate postoperative period, specifically after mid-urethral sling procedures for incontinence. The rates of de novo recurrent urinary tract infections and risk factors for these infections after polypropylene mesh placement are not well-characterized. The incidence of recurrent urinary tract infections after polypropylene mesh-augmented surgery for stress urinary incontinence and for pelvic organ prolapse is low. Risk factors for recurrent urinary tract infections after surgery include urinary retention, need for indwelling or intermittent catheterization, and preoperative history of recurrent urinary tract infections. While multiple theories exist, the current literature has not been able to determine risk factors for de novo recurrent urinary tract infections after mesh-augmented surgery in women without urinary retention or prior history of recurrent urinary tract infections. While some have suggested that the implant is coated with a bacterial biofilm resulting in chronic low levels of bacterial shedding, and thus predisposing certain individuals to chronic recurrent urinary tract infections, this theory remains unproven. It is also not known if revision of the mid-urethral slings or if removal of the mesh implant in women in this subgroup will result in the resolution of recurrent infections.