Incidence of vaginal erosion with different synthetic materials for suburethral sling in the treatment of Stress Urinary Incontinence: A systematic review

ABSTRACT

The aim of this systematic review is to compare the vaginalerosion rates in different synthetic materials used insuburethral slings in Tension Free Vaginal Tape (TVT-O/TOT) procedures in management of female stress urinaryincontinence.Methods: PRISMA 2009 framework was adopted for studydesign. Scholarly literature search was done usingMEDLINE, EMBASE, the Cochrane Library and ClinicalTrials.gov using selected keywords. Five articles fulfilled theinclusion and exclusion criteria. Our main outcome ofinterest is to review the ideal properties of the suburethralsling, procedure of insertion and post-surgical complicationfollowing the sling insertion primarily vaginal erosion.Results were compared using one way-ANOVA test andindependent T- test.Results: Total of 1725 subjects were available for analysisin the five studies. Monofilament polypropylene constituted92.5% of the total sample size from one study alone.Polyester (n= 16/51) causes higher incidence rate of vaginalerosion compared to monofilament polypropylene (31.4 vs.,4.7; p = 0.01). There was no difference in the vaginal erosionrate between monofilament polypropylene and multifilamentpolypropylene (4.7 vs, 14.1; p=0.055) as well as betweenmultifilament polypropylene and polyester (14.1 vs, 31.4;p=0.068). Although there was a marginally lower rate ofvaginal erosion in TVT-O over TVT, the difference was notsignificant. (5.6 vs., 6.4, p=0.468). Common presentations ofvaginal erosion were vaginal discharge, perineal pain anddyspareunia. Conclusion: Given the limited sample size, polyester slingmaterial appears to cause higher rates of vaginal erosion.No difference in erosion rate was seen between TVT andTVT-O.