ArticleWorld journal of urology2026
From implant to explant: urinary morbidity in women undergoing mesh removal.
Article in World journal of urology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundPelvic mesh implants are commonly used in female urology for the treatment of stress urinary incontinence and pelvic organ prolapse. However complications can be substantial and a number of the patients in this cohort proceed to mesh explantation. We evaluated urinary morbidity after pelvic mesh removal within New Zealand's National Mesh Service.
methodsRetrospective review of women undergoing pelvic mesh removal between March 2009 and December 2024 by the National Mesh Service. Primary outcomes were patient-reported urinary symptoms using validated instruments: Pelvic Floor Distress Inventory [PFDI] and International Consultation on Incontinence Questionnaire-Short Form [ICIQ-SF]. Secondary outcomes included clinician-reported symptoms at last follow-up, reintervention for incontinence, and complications (Clavien-Dindo).
resultsOf 345 patients (median age 58 years; median 105.3 months from insertion to removal), pain was the commonest indication for explantation, followed by bladder outlet obstruction/lower urinary tract symptoms. Among 184 with urodynamics, 32% met criteria for likely/definite outlet obstruction. Robotic assistance was used in 97 cases. Eight patients (2.3%) developed Grade III complications. Mean follow-up was 27.2 months. Post-removal, clinician-reported persistence of SUI, pain, and overactive bladder was seen in 30-40%, dyspareunia in 20%, recurrent urinary tract infection in 9%, and obstructive voiding in 12%. Overall, 25% needed concurrent procedure during pelvic mesh removal and 48% required ≥ 1 subsequent incontinence procedure. 6 patients ultimately underwent cystectomy. In 83 patients with paired PFDI, mean total scores improved from 168.4 to 149.6 (p < 0.05) with concordant subscale improvements. ICIQ-SF severity categories showed minimal overall shift.
conclusionsUrinary morbidity after pelvic mesh removal is common and frequently persists despite explantation, with high reintervention rates indicating chronicity. Findings support robust pre-operative counselling, multidisciplinary care, and prospective studies to define predictors and optimise surgical pathways.
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