No Correlation Between Presenting Symptoms Prior to Suburethral Sling Removal and Explanted Pathology Findings Suggests No Need for Routine Microscopic Pathology Evaluation

Objectives: We compared explanted midurethral sling (MUS) standard clinical pathology report findings with presenting symptoms before synthetic sling removal (SSR). Methods: An institutional review board-approved, prospectively maintained database of women who underwent a single SSR for MUS-related complication(s) was retrospectively reviewed for demographics, time interval between MUS placement and SSR, MUS type, and presenting symptoms before SSR. We compared 2 groups, one with MUS-related symptoms, including incontinence, voiding dysfunction, dyspareunia/pain, erosion, exposure, and/or urinary tract infections, and the second group characterized by self-reported symptoms attributed to the mesh material (systemic, autoimmune, or inflammatory disorder-mesh reaction group). Results: From 2005 to 2019, 332 of 473 women met study criteria, with 24 reporting mesh reaction-related symptoms. There was no difference in microscopic pathology findings between the 2 groups. In the mesh-related group, women were younger (P = 0.041) and had more pain/dyspareunia as their primary SSR indication (P = 0.002). That group was also significantly more likely to have a preexisting diagnosis of fibromyalgia (P < 0.001) and established autoimmune disorder (P = 0.033). No significant correlation between presenting findings and sling pathology was observed. Conclusions: No correlation was observed when comparing pathological findings of explanted MUS with presenting symptoms of MUS-related complications, including in women with mesh reaction-related concerns.