Patient-Related Risk Factors for Mesh Erosion Following Midurethral Sling Procedures: A Systematic Review and Meta-Analysis.

Abstract

<h4>Introduction and hypothesis</h4>Midurethral slings (MUS) are among the most commonly performed surgical treatments for stress urinary incontinence (SUI) worldwide, but mesh erosion remains a concerning complication. This systematic review and meta-analysis aimed to identify patient-related risk factors associated with mesh erosion following MUS procedures.<h4>Methods</h4>We conducted a comprehensive literature search in MEDLINE via PubMed, ScienceDirect, and Scopus from January 2010 to March 2025. Studies reporting risk factors for mesh erosion following synthetic MUS procedures for SUI were included. Two independent reviewers assessed study quality using the Newcastle-Ottawa Scale. Evidence certainty was evaluated using the GRADE approach. Fixed-effects meta-analyses were performed to calculate pooled odds ratios (ORs) with 95% confidence intervals (CIs).<h4>Results</h4>Six high-quality studies (n = 3068 patients) were included. The prevalence of mesh erosion ranged from 1.3% to 13.7% across studies. Significant risk factors for mesh erosion included prior pelvic surgery (OR 10.37; 95% CI 6.70-16.07), diabetes mellitus (OR 4.63; 95% CI 3.44-6.25), smoking (OR 3.38; 95% CI 2.54-4.48), obesity (BMI ≥ 30 kg/m²) (OR 2.79; 95% CI 1.69-4.62), and postmenopausal status (OR 2.34; 95% CI 1.67-3.27). GRADE assessment indicated moderate-certainty evidence for prior pelvic surgery, diabetes mellitus, smoking, and postmenopausal status.<h4>Conclusions</h4>This meta-analysis identifies prior pelvic surgery, postmenopausal status, diabetes mellitus, smoking, and obesity (BMI ≥ 30 kg/m²) as significant risk factors for mesh erosion following MUS procedures. These findings provide an evidence-based foundation for preoperative risk stratification and patient counseling.<h4>Trial registartion</h4>Prospero CRD420251026364.