From the Guidelines
Patients at risk for poor wound healing, such as those with a history of radiation therapy or significant scarring, should be strongly considered for alternative treatments to mesh-based mid-urethral slings to minimize the risk of mesh erosion. Risk factors for mesh erosion with a mesh-based mid-urethral sling include patient-specific factors such as advanced age, postmenopausal status (especially without estrogen replacement), diabetes, smoking, and immunocompromised states 1. Surgical technique factors also play a significant role, including excessive tension on the sling, improper placement too close to the urethra, inadequate tissue coverage, and concurrent procedures like hysterectomy or anterior repair. Material-related factors contribute as well, with certain mesh types (particularly older, higher-density meshes) carrying higher erosion risks. Previous pelvic surgeries, radiation therapy, and tissue atrophy from chronic steroid use increase risk by compromising local tissue integrity and vascularity. Postoperative factors such as infection, hematoma formation, and poor wound healing can also lead to mesh exposure.
Key Risk Factors
- Patient-specific factors:
- Advanced age
- Postmenopausal status (especially without estrogen replacement)
- Diabetes
- Smoking
- Immunocompromised states
- Surgical technique factors:
- Excessive tension on the sling
- Improper placement too close to the urethra
- Inadequate tissue coverage
- Concurrent procedures like hysterectomy or anterior repair
- Material-related factors:
- Certain mesh types (particularly older, higher-density meshes)
- Previous pelvic surgeries, radiation therapy, and tissue atrophy from chronic steroid use
- Postoperative factors:
- Infection
- Hematoma formation
- Poor wound healing To minimize erosion risk, surgeons should optimize patient factors when possible (smoking cessation, diabetes control, local estrogen for postmenopausal women), use proper surgical technique with appropriate tension, ensure adequate tissue coverage, and select appropriate mesh materials 1. Early recognition of mesh erosion is important as it can lead to pain, recurrent urinary tract infections, and sexual dysfunction if left untreated. According to the most recent guidelines, diabetic women planning to undergo sling surgery should be counseled regarding their higher risk for mesh erosion and reduced effectiveness compared with their non-diabetic counterparts 1.