Response to: “Advocating for Change: Lifting Mesh Suspension in
SUI Surgery Based on Established Literature and Long-Term TVT Study
Results”
Dear Dr. Aris Papageorghiou,
We would like to extend our gratitude to Rotem and O´Sullivan for their
positive and thoughtful comments on our long-term follow-up study on mid
urethral sling (MUS) surgery. We appreciate their recognition of the
importance of performing such long-term follow-up studies, especially in
surgical methods involving synthetic meshes.
We fully agree on the importance of differentiating between various
types of mesh and their distinct risk profiles. We also agree on the
important point of careful patient selection and counselling that might
increase success rates and minimize complication risks. One excellent
example is the association between higher BMI and lower subjective cure
rates found in our study and also later confirmed in a recent study from
Sweden, where obese women had higher rates of incontinence and lower
satisfaction than normal-weight women ten years after surgery (1).
Adding to the safety aspect of MUS surgery we would also highlight the
results from a recently published paper from our study population
showing that negative impact of urinary incontinence on sexual life
decreased after MUS surgery (2). Persistent pain after MUS in this
population was infrequent (3-4%) with no difference between sexually
active and inactive women.
Additionally, we would emphasis the importance of having national
quality registries with good coverage and data quality when it comes to
surgeries that involve implants, whether they are synthetic, autologous
or xenografts. Good registries are particularly useful when new
techniques are implemented as they can discover serious adverse events
early. Events may occur infrequently at the individual hospital or for
the individual surgeon but show a systematic pattern when results from
all reporting hospitals are continuously monitored and analyzed. Our
study demonstrates the value of such a high coverage quality register.
In the Norwegian Female Incontinence Registry preoperative and surgical
data as well as results from a mandatory 6-12 months follow-up are
continuously reported. This registry prepares several annual reports to
reporting hospitals on results and complications in which results from
each hospital department are compared to a national average (3). We
suggest that countries where polypropylene MUS have been banned might
benefit from having quality registries in place before reintroducing
MUS. Another important factor adding to safety is that everyone who
performs MUS surgery in Norway has received training from an experienced
surgeon in a one-to-one setting for at least 10 surgeries before
performing them on their own, which is considered good clinical
practice.
Summing up, we are pleased that our study contributes to the robust
evidence supporting the safety and efficacy of MUS surgery. We share the
commitment to precise risk assessment and patient-specific evaluations,
and we think standardised preoperative assessment and quality registries
are important to enable women and surgeons to make safe, evidence-based
and informed decisions.
Thank you again for your valuable comment and for highlighting the
significance of our findings.
Sincerely,
Dr. Berit Rein Solhaug, Dr. Rune Svenningsen, Dr. Maria Oyasaeter Nyhus
and Dr. Ingrid Volløyhaug
Acknowledgement: None
Conflict of interests: None
Contribution to Authorship:
BRS: Writing the letter
RS, MON, IV: Editing the letter
1. Lundmark Drca A, Westergren Söderberg M, Ek M. Obesity as an
independent risk factor for poor long-term outcome after mid-urethral
sling surgery. Acta Obstet Gynecol Scand. 2024;103(8):1657-63.2. Solhaug
BR, Svenningsen R, Nyhus M, Volløyhaug I. Long-term sexual function
after mid-urethral slings for stress urinary incontinence in women. Acta
Obstet Gynecol Scand. 2024.3. Dyrkorn OA, Staff AC, Kulseng-Hanssen S,
Dimoski T, Svenningsen R. The completeness and accuracy of the Norwegian
Female Incontinence Registry. Acta Obstet Gynecol Scand.
2020;99(12):1618-25.