Management of Mesh Exposure After Single-Incision Sling for Stress Incontinence

Objectives: As with traditional mid-urethral slings, mesh-related complications are a concern with single-incision mini slings (SIMS). The most common mesh-related complication is vaginal mesh exposure. Treatment options span from conservative management with observation and topical estrogen to mesh excision in the office or operating room (OR). This study aimed to report on the management of vaginal mesh exposure in patients with SIMS.

Methods: We reviewed all patients who underwent placement of an Altis® Single-Incision Sling at a large academic center over a six-year period. Outcomes included occurrence of vaginal mesh exposure and treatment of mesh exposure. Mesh exposure was diagnosed by physical examination in the office. Patients were treated conservatively with vaginal estrogen and observation, had mesh excised in the office, had mesh excised in the OR, or had excision in the office followed by excision in the OR.

Results: There were 130 patients who underwent SIMS placement during the study period. Eighteen (13.8%) patients had mesh exposure. The majority of patients were white (86.2%), overweight (mean body mass index 25.4 ± 4.4), non-smokers (96.2%), and post-menopausal (74.6%). Thirty-one (23.8%) patients used vaginal estrogen before and after sling placement.

Mean time to mesh exposure was 217 ± 223.9 days. Among the patients with mesh exposure, 2 (11.1%) had resolution of exposure with vaginal estrogen alone, 6 (33.3%) had local excision in the office, 7 (38.9%) had excision in the OR, and 3 (16.7%) had excision in the office followed by excision in the OR. Of the patients with successful excision in office, two (11.1%) required more than one excision.

Conclusions: The majority of patients with SIMS who have vaginal mesh exposure require mesh excision. While SIMS have less mesh than traditional full-length slings, mesh exposure rates are not lower with a rate of 13.8% in our study compared to approximately 2-4% for full-length slings. Additionally, only 11.1% of patients had resolution of exposure with topical estrogen alone, with the remainder requiring an office or OR procedure for excision. This information can be useful for both surgeons and their patients when considering SIMS versus full-length slings.