title: Analysis of patient and technical factors associated with midurethral sling mesh exposure and perforation.
abstract: OBJECTIVE
  To evaluate the technical and patient characteristics associated with the development of mesh perforation and exposure in patients after midurethral sling surgeries.
  
  
  METHODS
  After a retrospective review of referred patients, the risk of mesh perforation of the urinary tract over exposure in the vagina was analyzed with multivariate logistic regression, adjusting for the possible predictors of age, body mass index, smoking status at the time of mesh placement, presence of diabetes, type of sling placed, type of surgeon and trocar injury at the time of mesh placement.
  
  
  RESULTS
  A total of 77 women were identified, 27 with mesh perforation and 50 with mesh exposure. The patients' average body mass index was 29.2, and 13% were diabetic. Nine (33%) patients in the perforation group and two (4%) patients in the exposure group had evidence of trocar injury to the bladder or urethra at the time of mesh placement (P < 0.001). After multivariate logistic regression analysis, trocar injury (odds ratio 25.90, 95% confidence interval 2.84-236.58, P = 0.004) and diabetes (odds ratio 9.90, 95% confidence interval 1.1.25-78.64, P = 0.03) were associated with an increased risk of mesh perforation. Increased body mass index (odds ratio 0.88, 95% confidence interval 0.77-0.99, P = 0.05) was associated with a decreased risk of mesh perforation. Finally, postoperative hematomas and blood transfusions occurred more commonly in the mesh perforation group (15% vs 0%, P = 0.01).
  
  
  CONCLUSIONS
  Trocar injury, diabetes and bleeding complications at the time of surgery are associated with higher risk of mesh perforation in patients undergoing midurethral sling placement.
authors.affiliation: Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Osborn
authors.forename: Roger R
authors.initials: RR
authors.lastname: Dmochowski
authors.forename: Catherine J
authors.initials: CJ
authors.lastname: Harris
authors.forename: Jill J
authors.initials: JJ
authors.lastname: Danford
authors.forename: Melissa R
authors.initials: MR
authors.lastname: Kaufman
authors.forename: Stephen
authors.initials: S
authors.lastname: Mock
authors.forename: Laura Chang
authors.initials: LC
authors.lastname: Kit
authors.forename: Benjamin
authors.initials: B
authors.lastname: McCormick
authors.forename: W Stuart
authors.initials: WS
authors.lastname: Reynolds
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D053825:Suburethral Slings / Q000009:adverse effects*; D013526:Surgical Mesh / Q000009:adverse effects*; D014521:Urethra / Q000293:injuries; D014522:Urethral Diseases / Q000209:etiology*; D001743:Urinary Bladder / Q000293:injuries; D001745:Urinary Bladder Diseases / Q000209:etiology*; D013520:Urologic Surgical Procedures / Q000009:adverse effects; D014621:Vagina / Q000293:injuries; D014623:Vaginal Diseases / Q000209:etiology*
keywords: complication; erosion; extrusion; incontinence; trocar