title: Sling revision/removal for mesh erosion and urinary retention: long-term risk and predictors.
abstract: OBJECTIVE
  The objective of the study was to estimate the long-term risk of sling revision/removal after an initial sling and to assess indications (mesh erosion and urinary retention) and predictors of sling revision/removal.
  
  
  METHODS
  Using a population-based cohort of commercially insured individuals, we identified women 18 years old or older who underwent a sling (Current Procedural Terminology code 57288) between 2001 and 2010 and any subsequent sling revision/removal (Current Procedural Terminology code 57287). We estimated the cumulative risk of revision/removal annually and evaluated predictors of sling revision/removal using Kaplan-Meier survival curves and Cox proportional hazards models, respectively.
  
  
  RESULTS
  We identified 188,454 eligible women who underwent an index sling. The 9 year cumulative risk of sling revision/removal was 3.7% (95% confidence interval [CI], 3.5-3.9). At 1 year, this risk was already 2.2% and then increased to 3.2% at 4 years before plateauing. With regard to the indication for the sling revision/removal, a greater proportion was due to mesh erosion compared with urinary retention, with a 9 year risk of 2.5% (95% CI, 2.3-2.6) for mesh erosion vs 1.3% (95% CI, 1.2-1.4) for urinary retention. Age had an effect on the revision/removal rates for both mesh erosion and urinary retention, with the higher risks among those aged 18-29 years. The risk of revision/removal for mesh erosion and urinary retention was also elevated among women who had a concomitant anterior or apical prolapse procedure.
  
  
  CONCLUSIONS
  In this population-based analysis, the 9 year risk of sling revision/removal was relatively low at 3.7%, with 60% of revisions/removals caused by mesh erosion.
authors.affiliation: Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Michele
authors.initials: M
authors.lastname: Jonsson Funk
authors.forename: Nazema Y
authors.initials: NY
authors.lastname: Siddiqui
authors.forename: Virginia
authors.initials: V
authors.lastname: Pate
authors.forename: Cindy L
authors.initials: CL
authors.lastname: Amundsen
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Wu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020878:Device Removal; D005260:Female; D006801:Humans; D008875:Middle Aged; D011475:Prosthesis Failure; D012086:Reoperation; D012306:Risk; D053825:Suburethral Slings / Q000009:adverse effects*; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000601:surgery; D016055:Urinary Retention / Q000209:etiology / Q000601:surgery*