title: Is there an association between polypropylene midurethral slings and malignancy?
abstract: OBJECTIVE
  To examine any association between polypropylene mesh used in midurethral slings and malignancy in humans. Macroporous, monofilament polypropylene midurethral slings have been established as a safe and effective treatment for stress urinary incontinence. However, despite long-term studies supporting the efficacy and safety of midurethral slings, there have been concerns regarding the general risks of using mesh in transvaginal surgery. In addition, concerns have recently been raised about synthetic midurethral slings and a possible link with malignancy. Therefore, the goal of this work was to further assess any association between polypropylene mesh slings and malignancy.
  
  
  METHODS
  All sling procedures performed at our institution from 2004 to 2013 were retrospectively reviewed. From within this group, the International Classification of Disease codes for urethral cancer, vaginal cancer, and bladder cancer were reviewed.
  
  
  RESULTS
  From 2004-2013, 2545 procedures were performed. Of these, 2361 (96.3%) underwent polypropylene midurethral sling placement. Average follow-up after sling placement was 42.0 ± 38.6 months, with follow-up extending up to 122.3 months. The rate of bladder cancer after the sling procedure was 1 of 2361 (0.0%), with the same rate of vaginal cancer. No sarcomas were noted.
  
  
  CONCLUSIONS
  Overall, the rate of malignancy after polypropylene mesh midurethral sling placement in our series was 0.0% (2 of 2361). With a mean follow-up of almost 4 years and follow-up extending up to a maximum of 122.3 months, our series does not support any association between the polypropylene mesh used for midurethral slings and the development of malignancy in humans.
authors.affiliation: Center for Female Pelvic Medicine and Reconstructive Surgery, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH. Electronic address: kingab3@gmail.com.
authors.forename: Ashley B
authors.initials: AB
authors.lastname: King
authors.affiliation: Center for Female Pelvic Medicine and Reconstructive Surgery, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Anna
authors.initials: A
authors.lastname: Zampini
authors.affiliation: Center for Female Pelvic Medicine and Reconstructive Surgery, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Sandip
authors.initials: S
authors.lastname: Vasavada
authors.affiliation: Center for Female Pelvic Medicine and Reconstructive Surgery, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Courtenay
authors.initials: C
authors.lastname: Moore
authors.affiliation: Center for Female Pelvic Medicine and Reconstructive Surgery, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Raymond R
authors.initials: RR
authors.lastname: Rackley
authors.affiliation: Center for Female Pelvic Medicine and Reconstructive Surgery, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Howard B
authors.initials: HB
authors.lastname: Goldman
mesh_terms: D005260:Female; D006801:Humans; D008875:Middle Aged; D011126:Polypropylenes / Q000009:adverse effects*; D012189:Retrospective Studies; D053825:Suburethral Slings / Q000009:adverse effects*; D014523:Urethral Neoplasms / Q000209:etiology*; D001749:Urinary Bladder Neoplasms / Q000209:etiology*; D014625:Vaginal Neoplasms / Q000209:etiology*
chemical_list: D011126:Polypropylenes