Mid-urethral mesh-tapes have been widely regarded as the gold standard procedure for stress urinary incontinence. Concerns have been raised regarding the long term safety of vaginal mesh and its associated complications, and restrictions have been imposed on their use by regulatory bodies. For some patients, surgical excision is required to address mesh related complications. Our aim was to examine the incidence of worsening stress urinary incontinence following mid-urethral mesh-tape excision which required further surgical management.

A retrospective cohort study was undertook of all women undergoing surgical excision for mid-urethral mesh-tape related complications at our tertiary mesh centre between 2015 and 2020. Ethical approval was not deemed necessary. Data was gathered from electronic clinical records on patient demographics, intra-operative findings, extent of mesh removal and urinary symptoms at follow-up.

61 patients were identified as having undergone mid-urethral mesh-tape excision, and 54 (89%) attended follow-up. The most common indication for tape excision was pain, with 48 women (79%) reporting this. Mesh exposure was identified in 25 women (41%), and 9 women (15%) had tape perforation. Other complications were identified including sepsis (4/6.5%) and recurrent urinary tract infection (11.5%). 

44 (81.5%) patients reported new or worsening stress urinary incontinence (table 1). The incidence was higher following transobturator (85%) versus retropubic tape removal (69%). Rates of new or worsening stress urinary incontinence were similar regardless of whether total, complete vaginal or partial vaginal removal was undertaken (84%, 80% and 78% respectively). Additionally, 23 (43%) reported new or worsening overactive-bladder symptoms. 

Despite pelvic floor physiotherapy, 12 (23%) patients, to date, proceeded to surgery to manage stress urinary incontinence, with a further 6 patients awaiting surgery at the time of submission (table 2). The mean interval from tape excision to further surgery was 21 months. Although numbers are small, outcomes with autologous fascial sling appear to be good (n=7, 86% success rate) versus urethral bulking agent which were disappointing (n=4, 0% success rate).

Over 80% of patients developed new or worsening stress urinary incontinence following mid-urethral mesh-tape excision. Conservative management is often not sufficient to control these symptoms, and further SUI surgery was requested in around one third of patients. Additionally, the extent of tape removal did not have a significant effect on the risk of new or worsening incontinence, which may also be relevant when surgical planning.

There is a demonstrable significant risk of developing worsening stress urinary incontinence following mid-urethral mesh-tape excision. Patients must be counselled regarding these risks before undergoing surgery, and, where appropriate, conservative measures should be explored. Consideration should be taken, when counselling, to suitability for any further surgery that may be required following mesh-tape removal.