title: Predictors of vaginal mesh exposure after midurethral sling placement: a case-control study.
abstract: OBJECTIVE
  Female stress urinary incontinence is highly prevalent, and synthetic midurethral sling placement is the most common type of anti-incontinence surgery performed in the USA. We aimed to identify risk factors associated with surgery used to treated vaginal mesh exposure after midurethral sling placement for stress urinary incontinence.
  
  
  METHODS
  We identified women who underwent anti-incontinence procedures from January 2002 through December 2012. Patients with vaginal mesh exposure undergoing surgical repair after midurethral sling placement were compared with a control group without mesh exposure in a 1:3 ratio. Patients with ObTape sling placement (Mentor Corporation) were excluded. Logistic regression models were used to evaluate associations between clinical risk factors and vaginal mesh exposure.
  
  
  RESULTS
  Overall, 2,123 patients underwent primary sling placement, with 27 (1.3 %) having vaginal mesh exposure necessitating surgical repair. Patients with mesh exposure were more likely to have undergone previous bariatric surgery (P = 0.008), hemoglobin <13 g/dL (P = 0.006), premenopausal status (P = 0.008), age <50 years (P = 0.001), and the retropubic approach to sling placement (P = 0.03). Multivariate analysis identified these risk factors: previous bariatric surgery (odds ratio [OR], 7.0; 95 % CI, 1.1-61.4), retropubic approach (OR, 5.7; 95 % CI, 1.1-107.0), preoperative hemoglobin <13 g/dL (OR, 2.8; 95 % CI, 1.1-7.5), and premenopausal status (OR, 2.6; 95 % CI, 1.0-7.3). Among postmenopausal patients, those with mesh exposure were significantly more likely to receive preoperative estrogen therapy (OR, 12.4; 95 % CI, 2.7-57.8).
  
  
  CONCLUSIONS
  Previous bariatric surgery, retropubic approach, premenopausal status, and lower preoperative hemoglobin were associated with a significantly increased risk of surgery for vaginal mesh exposure after midurethral sling placement. Recognizing these factors can improve preoperative patient counseling.
authors.affiliation: Department of Urology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA. Linder.Brian@mayo.edu.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Linder
authors.affiliation: Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Sherif A
authors.initials: SA
authors.lastname: El-Nashar
authors.affiliation: Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Carranza Leon
authors.affiliation: Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Emanuel C
authors.initials: EC
authors.lastname: Trabuco
mesh_terms: D016022:Case-Control Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology* / Q000601:surgery; D019919:Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D053825:Suburethral Slings / Q000009:adverse effects*; D013526:Surgical Mesh / Q000009:adverse effects*; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D014621:Vagina / Q000601:surgery
keywords: Bariatric surgery; Complication; Midurethral sling; Vaginal exposure
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