From the Guidelines
There is a significant risk of erosion with midurethral slings, with an estimated rate of 3% as reported in a study published in The Journal of Urology 1.
Erosion Risk with Midurethral Slings
The risk of erosion is a well-documented complication of midurethral sling procedures. According to the study, synthetic slings at the midurethra have an estimated erosion rate of 3% 1.
Factors Contributing to Erosion
Several factors can contribute to the risk of erosion, including:
- Poor surgical technique
- Infection
- Smoking
- Diabetes
- Prior pelvic radiation
- Certain mesh materials
Symptoms and Treatment of Erosion
Symptoms of erosion may develop weeks to years after surgery and can include:
- Vaginal discharge
- Pain
- Bleeding
- Recurrent infections
- Partner discomfort during intercourse If erosion occurs, treatment typically involves surgical removal of the exposed mesh, which may be partial or complete depending on the extent of erosion.
Minimizing Erosion Risk
To minimize the risk of erosion, proper surgical technique with appropriate depth of mesh placement, use of lightweight polypropylene mesh, and good tissue handling are essential. Patients should be informed about this potential complication before undergoing surgery and should report any new symptoms promptly for early intervention.
From the Research
Erosion Risk with Midurethral Slings
- Erosion is a recognized complication of midurethral slings, with studies indicating that it can occur in a significant number of patients 2, 3, 4.
- The presentation of urethral erosion can vary, with symptoms including urinary tract infections, overactive bladder symptoms, recurrent incontinence, and dyspareunia 2.
- The management of midurethral sling erosion often requires partial or total removal of the sling, and may involve additional surgical interventions to repair the urethra and manage recurrent incontinence 2, 3.
- The use of autologous fascial slings has been proposed as an alternative to synthetic midurethral tapes, with the potential to reduce the risk of erosion and other complications 5.
- Prevention, diagnosis, and management of midurethral mesh sling complications, including erosion, are crucial to minimize risks and ensure optimal outcomes for patients 6.
Types of Midurethral Slings and Erosion Risk
- Trans-obturator tapes (TOT) and trans-vaginal tapes (TVT) are types of midurethral slings that have been associated with erosion risk 2, 3.
- Hybrid midurethral sling systems, which combine polypropylene mesh with autologous fascia, have also been reported to be associated with erosion risk 4.
- The choice of midurethral sling material and technique may influence the risk of erosion, with autologous fascial slings potentially offering a lower risk of complications compared to synthetic tapes 5.
Management and Outcomes
- The management of midurethral sling erosion often requires a multidisciplinary approach, involving urologists, gynecologists, and other healthcare professionals 2, 3.
- Outcomes after midurethral sling erosion can vary, with some patients experiencing resolution of symptoms and others requiring ongoing management and additional surgical interventions 2, 3.
- Further research is needed to fully understand the risks and benefits of midurethral slings and to develop effective strategies for preventing and managing complications, including erosion 2, 3, 6.