Impact of a mid-urethral synthetic mesh sling on long-term risk of systemic conditions in women with stress urinary incontinence: a national cohort study.

Autor: Muller P; London School of Hygiene & Tropical Medicine, London, UK.; Royal College of Obstetricians and Gynaecologists, London, UK., Gurol-Urganci I; London School of Hygiene & Tropical Medicine, London, UK.; Royal College of Obstetricians and Gynaecologists, London, UK., Thakar R; Royal College of Obstetricians and Gynaecologists, London, UK.; Croydon University Hospital, Croydon, UK., Ehrenstein MR; University College London, London, UK., Van Der Meulen J; London School of Hygiene & Tropical Medicine, London, UK.; Royal College of Obstetricians and Gynaecologists, London, UK., Jha S; British Society of Urogynaecology, London, UK.; Sheffield Teaching Hospitals, Sheffield, UK.
Jazyk: angličtina
Zdroj: BJOG : an international journal of obstetrics and gynaecology [BJOG] 2022 Mar; Vol. 129 (4), pp. 664-670. Date of Electronic Publication: 2021 Oct 05.
DOI: 10.1111/1471-0528.16917
Abstrakt: Objective: To compare the incidence of systemic conditions between women who had surgical treatment for stress incontinence with mesh and without mesh.
Design: National cohort study.
Setting: English National Health Service.
Population: Women with no previous record of systemic disease who had first-time urinary incontinence surgery between 1 January 2006 and 31 December 2013, followed up to the earliest of 10 years or 31 March 2019.
Methods: Competing-risks regression was used to estimate hazard ratios (HR), adjusted for patient characteristics, with HR > 1 indicating increased incidence following mesh surgery.
Main Outcome Measures: First postoperative admission with a record of autoimmune disease, fibromyalgia or myalgic encephalomyelitis up to 10 years following the first incontinence procedure.
Results: The cohort included 88 947 women who had mesh surgery and 3389 women who had non-mesh surgery. Both treatment groups were similar with respect to age, socio-economic deprivation, comorbidity and ethnicity. The 10-year cumulative incidence of autoimmune disease, fibromyalgia or myalgic encephalomyelitis was 8.1% (95% CI 7.9-8.3%) in the mesh group and 9.0% (95% CI 8.0-10.1%) in the non-mesh group (adjusted HR 0.89, 95% CI 0.79-1.01; P = 0.07). A sensitivity analysis including only autoimmune diseases as an outcome returned a similar result.
Conclusions: These findings do not support claims that synthetic mesh slings cause systemic disease.
Tweetable Abstract: No evidence of increased risk of systemic conditions after stress incontinence treatment with a mesh sling.
(© 2021 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
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