Since 2018, there has been a pause on the use of synthetic mesh/tape to treat stress urinary incontinence (SUI) and pelvic organ prolapse. Mesh centres in the UK have been faced with the challenge of managing mesh complications since. There is no consensus regarding benefits of concomitant SUI surgery for surgical management of mesh complications. The aim of this study was to assess patient reported outcomes from a series of women who had concomitant SUI procedures and compare such outcomes with women who had mesh removal only.

A prospective database including patient demographics, clinical presentation and indication for surgery, and operative details, was maintained from 2016 to 2021. An independent follow-up review was then carried out. Women reported the changes they experienced in the domains of pain, urinary incontinence, urinary tract infections, sexual function and mobility. This assessment was carried out using the PGI-I scale. Global outcomes of improvement were then assessed by asking patients the following questions:
Q1. How likely are you to recommend the surgery to a friend or family member?
Q2. With hindsight of outcome, would you still have gone through mesh complication surgery?
Q3. How do you rate the improvement in your overall wellbeing following surgery?
Women were asked to grade their answers on a 0-10 scale with 10 indicating the highest level of satisfaction.
Statistical analyses was carried out using the Mann-Whitney U test in order to compare the patient reported outcomes.

52 women who had surgical intervention for mesh complications were included. At the time of surgery, 29 women had concomitant SUI surgery whereas 23 women had mesh removal only. Median time for follow-up was 18months. Median age for concomitant surgery group was 52years, whilst that for mesh removal only was 51 years (p>0.05). In the concomitant surgery group, improvement in pain was reported in 52% (vs 52% for mesh removal only), incontinence 20% (vs 14% for mesh removal) and UTI 36% (vs 24% for mesh removal only). Improvement in the domains of sexual function and mobility was limited, with 8% of patients undergoing concomitant surgery reporting improvement in sexual function (vs 19% in mesh removal only) and 20% reporting improvement in mobility (vs 28% in mesh removal only group). The difference in PGI-I scores between the 2 groups were not statistically significant (p>0.05 in all domains). 
When analysing the responses to the Q1, Q2 and Q3 for patient reported outcome measures ( PROMS) the median scores were 9, 10, 6 for the concomitant surgery group. For the mesh removal only group, median scores were 10, 10, 8 respectively. The difference in PROMS for Q1 were statistically significant with p <0.05, but not for the other two questions.

This data confirms satisfactory short-term surgical outcomes are achievable for mesh removal surgery, however, there appears to be no significant difference in outcome in patients having concomitant SUI surgery vs women having mesh removal surgery alone. Post-operative assessment undertaken was independent of the operating surgeon which adds to the validity of these results. 
The minimal improvement in stress urinary incontinence in patients is rather disappointing, especially in the concomitant surgical group where there was no statistically significant improvement in incontinence when compared to women having had mesh removal surgery only. 
The global PROMs chosen reflect overall improvement rather than specific changes in isolated domains. Reported outcomes were very similar in both groups with the only statistically significant difference being in Q1, where patient having had concomitant surgery were more likely to recommend the surgical removal of mesh and SUI surgery to a friend than the patients who had mesh removal only. Reason for this remains uncertain, as there was no statistical difference in responses for improvements in the domains of pain, incontinence, UTI, sexual function and mobility.

Overall, patients are reporting improvement in their symptoms following surgery for mesh complications. However, it is difficult to establish whether there is any added benefit of concomitant SUI surgery vs mesh removal only in terms of patient satisfaction and improvement in symptoms. We recommend further studies including larger cohorts, to assess these outcomes and adequate patient counselling prior to procedures.