title: Postoperative Urinary Retention and Urinary Tract Infections Predict Midurethral Sling Mesh Complications.
abstract: OBJECTIVE
  To determine if postoperative urinary retention and urinary tract infections (UTIs) were predictors of future mesh complications requiring surgical intervention after midurethral sling (MUS).
  
  
  METHODS
  Administrative data in Ontario, Canada, between 2002 and 2013 were used to identify all women who underwent a mesh-based MUS. The primary outcome was revision of the transvaginal mesh sling (including mesh removal/erosion/fistula, or urethrolysis). Two potential risk factors were analyzed: postoperative retention (within 30 days of procedure) and number of postoperative emergency room visits or hospital admissions for UTI symptoms.
  
  
  RESULTS
  A total of 59,556 women had a MUS, of which 1598 (2.7%) required revision surgery. Of the 2025 women who presented to the emergency room or were admitted to hospital for postoperative retention, 212 (10.5%) required operative mesh revision. Of the 11,747 patients who had at least one postoperative UTI, 366 (3.1%) patients required operative mesh revision. In adjusted analysis, postoperative retention was significantly predictive of future reoperation (hazard ratio [HR] 3.46, 95% confidence interval [CI] 2.97-4.02), and this difference persisted when urethrolysis was excluded as a reason for sling revision (HR 3.08, 95% CI 2.62-3.63). Similarly, in adjusted analysis, each additional postoperative hospital visit for UTI symptoms increased the risk for surgical intervention for mesh complications (HR 1.74, 95% CI 1.61-1.87).
  
  
  CONCLUSIONS
  Postoperative urinary retention and hospital presentation for UTI symptoms are associated with an increased risk of reoperation for MUS complications. These patients should be followed and investigated for mesh complications when appropriate.
authors: Division of Urology, Department of Surgery, Western University, London, Ontario, Canada.
authors: Nahid
authors: N
authors: Punjani
authors: Institute for Clinical Evaluative Sciences, Ontario, Canada.
authors: Jennifer
authors: J
authors: Winick-Ng
authors: Division of Urology, Department of Surgery, Western University, London, Ontario, Canada; Institute for Clinical Evaluative Sciences, Ontario, Canada; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada. Electronic address: bkwelk@gmail.com.
authors: Blayne
authors: B
authors: Welk
mesh_terms: D005260:Female; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D053825:Suburethral Slings / Q000009:adverse effects*; D013526:Surgical Mesh / Q000009:adverse effects*; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000209:etiology*; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D016055:Urinary Retention / Q000453:epidemiology / Q000209:etiology*; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000209:etiology*