Comparison of Mesh Exposure with Single-Incision versus Full-Length Slings

Objectives: Mid-urethral slings (MUS) are the gold standard surgical treatment for stress urinary incontinence. In addition to only one incision, single-incision mini slings (SIMS) are shorter and thus have the theoretical advantage of reduced mesh complications. Data comparing the safety profiles of newer SIMS with traditional MUS are limited. Our objective was to compare rates of mesh exposure between single-incision and full-length slings.

Methods: We conducted a retrospective cohort analysis of all patients who underwent MUS placement by a single surgeon at a large academic center between 2016 and 2022. Slings included were Altis® Single-Incision Sling, Advantage Fit® Transvaginal Mid-Urethral Sling System, Obtryx II® Transobturator Mid-Urethral Sling System, and Solyx® Single-Incision Sling System. Our primary outcome was mesh exposure by sling type. Secondary outcomes included rates of bladder perforation and urinary retention by sling type.

Results: There was no difference by sling type in comorbidities that are known risk factors for mesh exposure including hypertension, diabetes, and smoking (Table 1). There were 369 patients who underwent MUS placement: 162 Advantage Fit, 130 Altis, 56 Obtryx, and 21 Solyx (Table 2). Mean follow-up was 22.4 [interquartile range (IQR) 11.8-33.0] months. Mean time to exposure was 7.6 [IQR 7.6-10.8] months.

Twenty-eight (7.6%) patients had mesh exposure. Rates were highest for Altis, with 13.8% (18/130), compared to Advantage Fit with 2.5% (4/162, p< 0.001). Exposure rates were higher, but not statistically significant, when comparing Altis to Obtryx (8.9%, 5/56, p=0.051) and Solyx (4.8%, 1/21, p=0.460). Concurrent hysterectomy and prolapse repair were more common with Altis (30.8% and 49.2%) compared to Advantage Fit (7.4% and 6.2%, p< 0.001).

In patients without hysterectomy, exposure rates were significantly higher with Altis (12.2%, 11/90) compared to Advantage Fit (2.7%, 4/150, p< 0.05). Similarly, in patients without prolapse repair, exposure rates were significantly higher with Altis (16.7%, 12/66) compared to Advantage Fit (2.6%, 4/152, p< 0.05). Bladder perforation and urinary retention occurred most often with Advantage Fit (8.6% and 19.1%).

Legends:
Table 1:
Numbers are mean± standard deviation or n(%)
* p< 0.05 when comparing Advantage Fit to Altis and Advantage Fit to Obtryx
** p< 0.05 when comparing Advantage Fit to Altis and to Obtryx
Table 2:
* p< 0.05 when comparing Advantage Fit to Altis, Obtryx and Solyx
** p< 0.05 when comparing Advantage Fit to Altis and to Obtryx
*** p< 0.05 when comparing Advantage Fit to Obtryx and Solyx
**** p< 0.05 when comparing Advantage Fit to Altis

Conclusions: In a tertiary care practice, Altis slings were associated with a significantly higher rate of mesh exposure compared to Advantage Fit. This was true of slings placed alone and with major prolapse surgery. This must be weighed against higher rates of retention and bladder perforation when considering sling approach.