Sunday June 30, 2019 from 07:30 to 09:00
Association between stress incontinence surgery and pelvic malignancy: A population-based cohort study
Humberto Vigil1, Christopher Wallis1, Joseph R. LaBossiere2, Sender Herschorn1, Lesley Carr1.
1Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; 2Division of Urology, University of Alberta, Edmonton, AB, Canada
Introduction: Stress incontinence surgery was revolutionized by the mid-urethral sling. However, concerns with respect to the implantation of pelvic mesh continue to exist. One such concern is a potential link between pelvic mesh and malignancy. We sought to evaluate the association between stress incontinence surgery (including transvaginal mesh) and carcinogenesis in a large, population-based cohort.
Methods: Using administrative data, we performed a retrospective cohort of all adult women who underwent stress incontinence surgery from 1994–2016 in Ontario, Canada. The primary outcome of interest was the diagnosis of pelvic cancer. The standardized incidence rate (SIR) was calculated to evaluate for a potential increased risk of malignancy. Subgroup analyses were performed for individual malignancies and urethral sling patients.
Results: A total of 120 999 women underwent a procedure for stress incontinence in the form of urethropexy, combined abdominal/vaginal sling, bulking agent, or urethral sling in Ontario during the study period. Urethral sling accounted for 63% of procedures. Median followup was 9.3 years (interquartile range [IQR] 5.4–14.4). Over a total of 1 221 668 person-years of observation, 935 pelvic cancers were observed. Based on an age-stratified sample of the general population, the expected number of cases was 1146 (SIR for any pelvic cancer 0.816, 95% confidence interval [CI] 0.764–0.870). Similarly, among patients who underwent a urethral sling, the SIR was 0.831 (95% CI 0.758–0.909).
Conclusions: Stress incontinence surgery including the transvaginal implantation of mesh was not associated with an increased risk of pelvic malignancy in a large population-based cohort.