Surgical Removal of Midurethral Sling in Women Undergoing Surgery for Presumed Mesh-Related Complications: A Systematic Review.

Autor:	Doyle PJ; Departments of Obstetrics and Gynecology and Urology, University of Rochester School of Medicine and Dentistry, Rochester, New York; the Departments of Obstetrics and Gynecology and Urology, New York Medical College, Valhalla, New York; the Center for Evidence Synthesis in Health, Brown School of Public Health, Brown University, Providence, Rhode Island; the Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, California; the Department of Obstetrics and Gynecology, Harvard Medical School, Boston, Massachussetts; the Department of Obstetrics and Gynecology, Albert Einstein College of Medicine, New York, New York; International Medical Response, Brooklyn, New York; the Department of Obstetrics and Gynecology, University of Texas Health Science Center San Antonio, San Antonio, Texas; Bela Vida Urogynecology, Celebration, Florida; the Department of Obstetrics and Gynecology, the Permanente Medical Group, Roseville, California; the Department of Obstetrics and Gynecology, Medical College of Wisconsin, Waukesha, Wisconsin; the Department of Obstetrics and Gynecology, Cooper Medical School of Rowan University, Camden, New Jersey; the Department of Obstetrics and Gynecology, HCA/UCF Consortium, Gainesville, Florida; and the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics & Gynecology, University of New Mexico, Albuquerque, New Mexico., Grimes CL, Balk EM, Wieslander C, Richardson M, Mamik MM, Sleemi A, Alas A, Kudish B, Walter AJ, Aschkenazi S, Mama S, Foda M, Meriwether KV
Jazyk:	angličtina
Zdroj:	Obstetrics and gynecology [Obstet Gynecol] 2022 Feb 01; Vol. 139 (2), pp. 277-286.
DOI:	10.1097/AOG.0000000000004646
Abstrakt:	Objective: To assess whether some, or all, of the mesh needs to be removed when a midurethral sling is removed for complications. Data Sources: A systematic review and meta-analysis was conducted. MEDLINE, Cochrane, and ClinicalTrials.gov databases from January 1, 1996, through May 1, 2021, were searched for articles that met the eligibility criteria with total, partial, or a combination of anti-incontinence mesh removal. Methods of Study Selection: All study designs were included (N≥10), and a priori criteria were used for acceptance standards. Studies were extracted for demographics, operative outcomes, and adverse events. Meta-analysis was performed when possible. Tabulation, Integration, and Results: We double-screened 11,887 abstracts; 45 eligible and unique studies were identified. Thirty-five were single-group studies that evaluated partial mesh removal, five were single-group studies that evaluated total mesh removal, and five were studies that compared partial mesh removal with total mesh removal. All of the studies were retrospective in nature; there were no randomized controlled studies. Comparative studies demonstrated that partial mesh removal had lower rates of postoperative stress urinary incontinence (SUI) than total mesh removal (odds ratio 0.46, 95% CI 0.22-0.96). Single-group studies supported lower rates of postoperative SUI with partial mesh removal compared with total mesh removal (19.2% [95% CI 13.5-25.7] vs 48.7% [95% CI 31.2-66.4]). Both methods were similar with respect to associated pain, bladder outlet obstruction, mesh erosion or exposure, and lower urinary tract symptoms. Adverse events were infrequent. Conclusion: Postoperative SUI may be lower with partial mesh removal compared with total mesh removal. Other outcomes were similar regardless of the amount of mesh removed. Systematic Review Registration: PROSPERO, CRD 42018093099. Competing Interests: Financial Disclosure Paula Jaye Doyle is the Chief Medical Officer of EndoGlow, LLC. Cara L. Grimes provided expert testimony for Johnson and Johnson, Consultant Provepharm, Inc. Ethan M. Balk has been a consultant for Society of Gynecologic Surgeons and American Association of Gynecologic Laparoscopists. Bela Kudish disclosed receiving payment from Intuitive Surgical (consultancy for training in robotic surgery, unrelated to the content of this article). Kate V. Meriwether has been a consultant for RBI Medical, and received travel reimbursement from SGS (voting board member as research chair) and book editing and authorship royalties from Elsevier. The other authors did not report any potential conflicts of interest. (Copyright © 2022 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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