title: Evaluation of the local carcinogenic potential of mesh used in the treatment of female stress urinary incontinence.
abstract: OBJECTIVE
  To evaluate the carcinogenic potential of implanted synthetic mesh midurethral slings in the treatment of female stress urinary incontinence.
  
  
  METHODS
  We identified female patients undergoing implantation of mesh materials for stress urinary incontinence at our institution from 1 January 2002 to 31 December 2012. This was accomplished by querying the medical records for CPT code 57288 ("sling operation for stress incontinence") and a subsequent chart review to identify patients who underwent synthetic mesh sling placement. Medical records were then evaluated for the documentation of bladder, urethral, vaginal, cervical, uterine or ovarian cancers via the International Classification of Disease (ninth edition) coding. A chart review of patients with a cancer diagnosis was performed for verification of the diagnosis and evaluation of the temporal relationship with sling placement.
  
  
  RESULTS
  During the study period, 2,474 patients underwent polypropylene midurethral sling placement. The median age was 57 years (IQR 47, 69) and the median follow-up was 60 months (IQR 23.3, 94.9). Overall, 51 patients also had a cancer diagnosis (8 bladder cancers, 7 vaginal malignancies, 8 ovarian carcinomas, 26 endometrial cancers, 2 cervical malignancies); however, only 2 cancers (0.08 %, 2 out of 2,474) developed following sling placement (a vaginal melanoma 3 years after sling placement and an ovarian tumor 1 year after sling placement). No cases of sarcoma formation, bladder, urethral or squamous cell carcinomas were identified.
  
  
  CONCLUSIONS
  With a median follow-up of 5 years after synthetic midurethral sling placement, development of pelvic malignancy was rare (0.08 %) and unlikely to be secondary to foreign body reaction from the implanted material.
authors: Department of Urology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
authors: Brian J
authors: BJ
authors: Linder
authors: Department of Obstetrics and Gynecology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
authors: Emanuel C
authors: EC
authors: Trabuco
authors: Department of Obstetrics and Gynecology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
authors: Daniel A
authors: DA
authors: Carranza
authors: Department of Obstetrics and Gynecology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
authors: John B
authors: JB
authors: Gebhart
authors: Department of Obstetrics and Gynecology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
authors: Christopher J
authors: CJ
authors: Klingele
authors: Department of Obstetrics and Gynecology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA. Occhino.John@mayo.edu.
authors: John A
authors: JA
authors: Occhino
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D005833:Genital Neoplasms, Female / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D008875:Middle Aged; D011126:Polypropylenes; D012189:Retrospective Studies; D053825:Suburethral Slings / Q000009:adverse effects*; D013526:Surgical Mesh / Q000009:adverse effects*; D001749:Urinary Bladder Neoplasms / Q000453:epidemiology / Q000209:etiology*; D014550:Urinary Incontinence, Stress / Q000601:surgery*
chemical_list: D011126:Polypropylenes
keywords: Cancer; Carcinogenesis; Complication; Midurethral sling