Preoperative vaginal estrogen and midurethral sling exposure: a retrospective cohort study.
OBJECTIVE
We evaluated whether the use of estrogen vaginally prior to synthetic midurethral sling insertion mediates the risk of mesh exposure. A secondary aim was to evaluate other factors that may be associated with mesh exposure.


METHODS
We performed a retrospective cohort study of patients undergoing midurethral sling insertion from January to December 2010 within the Southern California Permanente Medical Group. Women who used estrogen vaginally prior to surgery were classified as those who filled a prescription between 1 and 45 days before surgery or whose medical records indicated its use at the time of preoperative evaluation. Logistic regression analysis was used to calculate odds ratios (OR) and 95 % confidence intervals (CI) for factors associated with mesh exposure while controlling for confounding variables.


RESULTS
A total of 1544 patients met inclusion criteria, of whom 248 (16.1 %) used estrogen vaginally prior to surgery. Mean age was 53.7 years (range 27-89). Thirty-seven (2.4 %) women were diagnosed with mesh exposure, of whom 19 underwent surgical reoperation. In multivariate logistic regression analysis, preoperative use of estrogen vaginally was not associated with the risk of mesh exposure (OR 0.79, CI 0.26-2.38, p = 0.67). Age, body mass index, menopausal status, use of hormone replacement therapy, smoking status, and diabetes were not associated with risk of mesh exposure.


CONCLUSIONS
Preoperative use of estrogen vaginally did not appear to mediate the risk of mesh exposure following midurethral sling placement in this cohort.
Department of Obstetrics and Gynecology, University of California Irvine Medical Center, 101 The City Drive, Building 56, Suite 800, Orange, CA, 92868, USA. lcadish@uci.edu.
Lauren A
LA
Cadish
Department of Obstetrics and Gynecology, University of California Irvine Medical Center, 101 The City Drive, Building 56, Suite 800, Orange, CA, 92868, USA.
Elizabeth H
EH
West
Department of Obstetrics and Gynecology, University of California Irvine Medical Center, 101 The City Drive, Building 56, Suite 800, Orange, CA, 92868, USA.
Jessica
J
Sisto
Department of Obstetrics and Gynecology, University of California Irvine Medical Center, 101 The City Drive, Building 56, Suite 800, Orange, CA, 92868, USA.
Teresa
T
Longoria
Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, CA, USA.
Judith D
JD
Bebchuk
Department of Obstetrics and Gynecology, Southern California Permanente Medical Group, Irvine Medical Center, Irvine, CA, USA. Emily.L.Whitcomb@kp.org.|Kaiser Permanente Irvine Medical Center, 6650 Alton Parkway, Irvine, CA, 92618, USA. Emily.L.Whitcomb@kp.org.
Emily L
EL
Whitcomb
D000282:Administration, Intravaginal; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004967:Estrogens / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D011300:Preoperative Care; D012189:Retrospective Studies; D053825:Suburethral Slings / Q000009:adverse effects*
D004967:Estrogens
Estrogen; Mesh exposure; Midurethral sling