Abstract
Introduction and hypothesis
To evaluate the carcinogenic potential of implanted synthetic mesh midurethral slings in the treatment of female stress urinary incontinence.
Methods
We identified female patients undergoing implantation of mesh materials for stress urinary incontinence at our institution from 1 January 2002 to 31 December 2012. This was accomplished by querying the medical records for CPT code 57288 (“sling operation for stress incontinence”) and a subsequent chart review to identify patients who underwent synthetic mesh sling placement. Medical records were then evaluated for the documentation of bladder, urethral, vaginal, cervical, uterine or ovarian cancers via the International Classification of Disease (ninth edition) coding. A chart review of patients with a cancer diagnosis was performed for verification of the diagnosis and evaluation of the temporal relationship with sling placement.
Results
During the study period, 2,474 patients underwent polypropylene midurethral sling placement. The median age was 57 years (IQR 47, 69) and the median follow-up was 60 months (IQR 23.3, 94.9). Overall, 51 patients also had a cancer diagnosis (8 bladder cancers, 7 vaginal malignancies, 8 ovarian carcinomas, 26 endometrial cancers, 2 cervical malignancies); however, only 2 cancers (0.08 %, 2 out of 2,474) developed following sling placement (a vaginal melanoma 3 years after sling placement and an ovarian tumor 1 year after sling placement). No cases of sarcoma formation, bladder, urethral or squamous cell carcinomas were identified.
Conclusions
With a median follow-up of 5 years after synthetic midurethral sling placement, development of pelvic malignancy was rare (0.08 %) and unlikely to be secondary to foreign body reaction from the implanted material.
Similar content being viewed by others
Abbreviations
- IQR:
-
Inter-quartile range
References
Oppenheimer BS, Oppenheimer ET, Stout AP, Willhite M, Danishefsky I (1958) The latent period in carcinogenesis by plastics in rats and its relation to the presarcomatous stage. Cancer 11(1):204–213
Ostergard DR, Azadi A (2014) To mesh or not to mesh with polypropylene: does carcinogenesis in animals matter? Int Urogynecol J 25(5):569–571
Birolini C, Minossi JG, Lima CF, Utiyama EM, Rasslan S (2014) Mesh cancer: long-term mesh infection leading to squamous-cell carcinoma of the abdominal wall. Hernia 18(6):897–901
Locke JR, Hill DE, Walzer Y (1985) Incidence of squamous cell carcinoma in patients with long-term catheter drainage. J Urol 133(6):1034–1035
Rogo-Gupta L, Litwin MS, Saigal CS, Anger JT, Urologic Diseases in America Project (2013) Trends in the surgical management of stress urinary incontinence among female Medicare beneficiaries, 2002–2007. Urology 82(1):38–41
Wu JM, Matthews CA, Conover MM, Pate V, Jonsson Funk M (2014) Lifetime risk of stress urinary incontinence or pelvic organ prolapse surgery. Obstet Gynecol 123(6):1201–1206
Chapple CR, Raz S, Brubaker L, Zimmern PE (2013) Mesh sling in an era of uncertainty: lessons learned and the way forward. Eur Urol 64(4):525–529
Brown LK, Fenner DE, Berger MB, Delancey JO, Morgan DM, Patel DA, Schimpf MO (2013) Defining patients' knowledge and perceptions of vaginal mesh surgery. Female Pelvic Med Reconstr Surg 19(5):282–287
King AB, Zampini A, Vasavada S, Moore C, Rackley RR, Goldman HB (2014) Is there an association between polypropylene midurethral slings and malignancy? Urology 84(4):789–792
Kwon SY, Latchamsetty KC, Benson J, Carreno M (2012) Inflammatory myofibroblastic tumor of the urinary tract following a TVT. Female Pelvic Med Reconstr Surg 18(4):249–251
Lin HZ, Wu FM, Low JJ, Venkateswaran K, Ng RK (2015) A first reported case of clear cell carcinoma associated with delayed extrusion of midurethral tape. Int Urogynecol J. doi:10.1007/s00192-015-2876-5
Goldman HB, Dwyer PL (2015) Polypropylene mesh slings and cancer: an incidental finding or association? Int Urogynecol J. doi:10.1007/s00192-015-2892-5
United States Food and Drug Administration (2011) Serious complications associated with transvaginal placement of surgical mesh for pelvic organ prolapse: FDA Safety Communication
Witherspoon P, Bryson G, Wright DM, Reid R, O'Dwyer PJ (2004) Carcinogenic potential of commonly used hernia repair prostheses in an experimental model. Br J Surg 91(3):368–372
Jennings TA, Peterson L, Axiotis CA, Friedlaender GE, Cooke RA, Rosai J (1988) Angiosarcoma associated with foreign body material. A report of three cases. Cancer 62(11):2436–2444
McGregor DB, Baan RA, Partensky C, Rice JM, Wilbourn JD (2000) Evaluation of the carcinogenic risks to humans associated with surgical implants and other foreign bodies—a report of an IARC monographs programme meeting. International Agency for Research on Cancer. Eur J Cancer 36(3):307–313
Siegel RL, Miller KD, Jemal A (2015) Cancer statistics, 2015. CA Cancer J Clin 65(1):5–29
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflicts of interest
None.
Rights and permissions
About this article
Cite this article
Linder, B.J., Trabuco, E.C., Carranza, D.A. et al. Evaluation of the local carcinogenic potential of mesh used in the treatment of female stress urinary incontinence. Int Urogynecol J 27, 1333–1336 (2016). https://doi.org/10.1007/s00192-016-2961-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00192-016-2961-4