Success Story: Surgery for Urinary Incontinence

Vaginal mesh sling surgery for stress urinary incontinence may be more successful than thought

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) Surgical mesh slings appear to be an effective way to treat urinary incontinence in women — despite past concerns.

A new study that looked at the potential complications of synthetic vaginal mesh sling surgeries to treat stress urinary incontinence (SUI) found that the risk of needing a second surgery to remove or revise the mesh was relatively low. This is in spite of recent concerns raised by the US Food and Drug Administration (FDA) about the potential risk of complications for these surgeries.

SUI is an involuntary release of urine during any activity that puts pressure on the bladder, such as coughing, sneezing or heavy lifting. This condition occurs when the muscles of the pelvic floor become weakened. Women are more susceptible to SUI after childbirth.

A synthetic vaginal mesh sling can be surgically inserted into the pelvic area to provide support and relieve symptoms. This is the most common procedure performed in women with SUI.

The FDA previously stated that complications from vaginal mesh surgery were not uncommon. Therefore, surgeons are recommended to have extra training before performing these surgeries.

In this study, a team of researchers led by Blayne Welk, MD, a urologist at the University of Western Ontario, looked at 59,887 women who underwent the procedure between 2002 and 2012.

These researchers focused on risk factors among surgeons and patients — in particular whether the slings had to be removed or revised due to complications.

Only 2.2 percent of these women needed a second surgery, Dr. Welk and team found.

If a patient had more than one vaginal mesh procedure, however, complications were more likely.

Patients whose surgeons regularly performed vaginal mesh procedures were less likely to have complications, Dr. Welk and colleagues found. These surgeons were more likely to practice in academic medical centers.

According to Dr. Welk and team, while these findings did not support the FDA's concerns about potential complications, they did support the FDA's recommendations for more training among surgeons.

In an editorial about this study, Christian P. Meyer, MD, and Quoc-Dien Trinh, MD, of Brigham and Women’s Hospital in Boston, wrote that patients may not have the option to travel to an academic medical center for their surgeries.

"The results of [this study] suggest that treatment of stress urinary incontinence would be better served by a high-volume surgeon; however, for such a common procedure, this solution may be impractical or impossible," Drs. Meyer and Trinh wrote.

Because of this, Drs. Meyer and Trinh said local surgeons should be mentored by more experienced surgeons.

The study and editorial were published Sept. 9 in the journal JAMA Surgery.

The Ontario Ministry of Health and Long-Term Care and the Academic Medical Organization of Southwestern Ontario funded this research. Dr. Welk disclosed funding from pharmaceutical company Astellas Canada.

Review Date: 
September 10, 2015
Last Updated:
September 18, 2015