Abstract

Introduction: Stress urinary incontinence (SUI) is the most common type of urinary incontinence in women. Currently, the first surgical treatment option for patients with SUI is tension-free midurethral slings due to their high effectiveness. However, they are not without complications. The risk of complications requiring a new intervention is 1.2% per year and increases cumulatively to 3.3% at 10 years. It is important to know the local rate and types of complications, and the profile of the affected patients. Objective: To characterize patients undergoing surgical reoperation due to com- plications of anti-incontinence mesh during the last 5 years at a public hospital. Methods: Retrospective descriptive study of surgeries due to complications of anti-incontinence meshes performed between 2019 and 2023. The sur- gical protocols were obtained and the outpatient care of these patients was subsequently reviewed to rescue clinical data and perform data characterization. Classification of complications was performed according to IUGA/ICS definitions. Statistical analysis was realized by determining absolute and relative frequencies. Results: In the 5 years analyzed, 872 surgeries related to anti-incontinence meshes were performed. Of these, 43 (4.65%) were due to mesh com- plications. The average age and parity was 58.5 years (SD ± 8.3) and 3 (SD ± 1.2), correspondingly. 72.2% had genital atrophy, 43.5% were smokers and 7.1% used corticosteroids. Regarding the primary surgery performed, in 30 patients (69.8%) it was TOT and in 13 (30.2%) it was TVT. In 29 patients (76.3%) the first surgeon was a gynecologist trained in pelvic floor and in 14 patients (23.7%) the first surgeon was a gynecology resident. Intraoperative complications were described in 5 patients (13.2%): bladder perforation in 4 patients and urethral injury in 1 patient. Regarding complications that required reintervention, in 14 patients (32.6%) the mesh was folded or under tension, in 3 patients (7%) there was exposure <1 cm, in 17 patients (39.5%) there was expo- sure >1 cm or extrusion, in 18 patients (41.9%) dyspareunia, in 15 patients (34.9%) vaginal pain, in 5 patients (11.6%) vaginal bleeding,in 3 patients (7%) vaginal infection, in 1 patient (2.3%) acute urinary retention and in 1 patient (2.3%) intravesical mesh. 6 patients (14%) presented asymptomatic mesh exposure or extrusion, only detected on physical examination. The surgical reinterventions that were performed were total vaginal mesh removal in 23 patients (53.5%), partial mesh removal in 13 patients (30.2%), diagnostic cystoscopy in 4 patients (9.3% ), new mucosal suture in 2 patients (4.7%), cutting of the mesh in the middle area in 2 patients (4.7%) and granuloma resection in 1 patient (2.3%). Conclusions: Our described complications were similar to that reported in the litera- ture. TOT was more frequent among complications. The most common complication in our series was mesh extrusion and exposure. Despite the high effectiveness of the meshes, it is important to provide long- term follow-up of the prosthetic materials to determine complications.