SUFU20: International Perspectives on the Use of Synthetic Mesh Slings

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South AmericaPanelist: Marcio A. Averbeck, MD, MSc, PhDUKPanelist: Tamsin J. Greenwell, MBChB, MD FRCS(Urol)CanadaPanelist: Blayne K. Welk, MDContinental EuropePanelist: Matteo Balzarro, MDBlayne K. Welk, MDSt. Josephs HospitalLondon, ONConsistent with many other societies, the Canadian Urology Association supports the use of midurethral synthetic slings for the treatment of stress incontinence. However, these procedures have decreased substantial over the last 10 years in Canada in response to public awareness of the legal cases and the North American regulatory warnings. Marcio A. Averbeck, MD, MSc, PhDMoinhos de Vento HospitalPorto Alegre, BrazilAccording to a cross-sectional study, which used a 37-item internet-based survey applied to members of urologic and gynecologic associations from 18 countries in Latin America, most participants (75.2%) indicated that the use of mesh has declined after FDA warnings, and 41.9% considered this has had a negative effect in the use of midurethral synthetic slings (MUS) as well (1). One of the largest series of MUS in Southern Brazil has been presented during the 2014 ICS Annual Congress in Rio de Janeiro (2). From January 2008 to December 2013, 315 patients underwent TOT implantation at a single terciary hospital. Mean age was 58.66±11.87 years. Postoperative continence rate was 78% at a mean follow-up of 33.83±20.67 months (6 to 72 months). Surgical complications were found in 17.4% of patients. Most frequent complications were dyspareunia (16 cases), groin pain (12 cases), newonset of recurrent urinary tract infections (5 cases), de novo urgency (5 cases), vaginal erosion (3 cases) and persistent urinary retention requiring urethrolysis (3 cases). 90.3% of patients stated that they did not regret undergoing TOT implantion and were happy with their surgical outcomes.Consistent with many other international medical societies, the Brazilian Society of Urology (SBU) still supports the use of midurethral synthetic slings for the treatment of stress urinary incontinence in women. However, public hospitals usually have budget restrictions and the ‘mesh controversy’ has been perceived as an excuse to postpone regular acquisition of surgical materials (eg. synthetic sling kits). Curiously, the decision-making process for surgical interventions is mostly surgeon-centered in most South-American countries.References1. Plata M, Bravo-Balado A, Robledo D, Castaño JC, Averbeck MA, Plata MA, Cataño JG, Caicedo JI, Trujillo CG. Trends in pelvicorgan prolapse management in Latin America. Neurourol Urodyn. 2018 Mar;37(3):1039-1045. doi: 10.1002/nau.23392. Epub 2017 Sep 6.2. Averbeck MA, Wachter L, Dörr D, Schneider N, Ramos J, Ledesma AG, Prado Schmidt A, Camargo SF. Long-term outcomes oftransobturator tension-free midurethral slings for the surgical treatment of stress urinary incontinence in women. Podium presentationduring ICS Congress in Rio de Janeiro (2014). Session 16; abstract 271.