Outcomes after laparoscopic removal of retropubic midurethral slings for chronic pain

Abstract

Introduction and hypothesis: Midurethral slings (MUS) are an established treatment for stress urinary incontinence (SUI), with good objective outcomes and low rates of complications. However, large population-based registry studies highlighted long-term complications from polypropylene slings including erosion, dyspareunia and chronic pain. With recent highly negative media coverage, many women are presenting with chronic pain attributed to the mesh to request complete removal. The available literature provides limited evidence on safety, symptom resolution and incontinence following MUS removal.

Methods: We identified all patients who underwent laparoscopic removal of MUS mesh at our hospital between 2011 and 2016. We extracted data from medical records to assess operative safety and contacted all patients by questionnaire that incorporated pain scales, symptom severity and satisfaction.

Results: A total of 56 women were assessed. Removal occurred at a median of 44 months following sling insertion (range 3-192). Mean operative time was 74 min (range 44-132). Two patients were returned to theatre (one at 24 hours and one at 14 days) to evacuate a retropubic haematoma, but no visceral injuries occurred. The median inpatient stay was 2 days (range 1-7). Of the 46% of patients who returned the questionnaire (n = 26), 88% said they would recommend the procedure. There was a median 6-point decrease in pain scores (10-point numerical scale, p < 0.0001); 44.6% reported worsening SUI, more common with removal of the suburethral mesh [odds ratio (OR) 10.72 95% confidence interval (CI) 1.10-104].

Conclusions: Laparoscopic removal of MUS is feasible and effective but carries a risk of worsening SUI.

Keywords: Chronic pain; Laparoscopic removal; Mesh; Patient satisfaction; Retropubic midurethral slings; Safety.