Comparison of treatment pathways for isolated mesh associated pain syndrome (I‐ MAPS ) secondary to pelvic mesh devices for stress urinary incontinence ( SUI )

Abstract

OBJECTIVE: The aim of this retrospective observational cohort study was to compare the outcome of surgical, combined and non-surgical pathways of isolated mesh associated pain syndrome (I-MAPS) following insertion of a single continence tape. METHODS: Women with a single continence tape who experienced I-MAPS accessing the service between 2018 and 2023 were included in the study. Three cohorts of women were compared: those who chose surgery alone, a combination of surgical and non-surgical therapies and those who chose non-surgical treatments alone. Pain assessments were undertaken before and after treatment using the pain DETECT questionnaire (PDQ). Health related quality of life (QOL) was assessed using the EuroQol 5-dimension (EQ 5D) and WHO-five well-being Index (WHO-5) questionnaires. Satisfaction with treatment was ascertained using the patient global impression of improvement (PGI-I) score. RESULTS: A total of 280 women were seen with I-MAPS over 5 years. Of the 174 choosing to have further treatment, 68% (n = 119/174) requested surgery and 32% (n = 55/174) selected non-surgical therapies alone. Of the 107 followed-up 6-months post treatment, 19% (n = 20/107) had surgery alone, 50% (n = 54/107) had a combination of surgical and non-surgical therapies and 31% (n = 33/107) had non-surgical management alone. At baseline there was no difference in the PDQ scores between treatment groups. Following treatment there was no significant difference in PGI-I or change in PDQ scores across the groups. Of those who had surgery alone, 65% (n = 13/20) felt improved versus 61% (n = 21/33) who had combined treatments versus 64% (n = 21/33) who had non-surgical treatment alone. Surgery was associated with an 86% (n = 64/74) recurrence in stress urinary incontinence (SUI) and 23% (n = 17/74) had other surgery-related complications. CONCLUSION: This cohort study identified equivalent satisfaction rates in patients who received surgical, combined and non-surgical treatment of I-MAPS. This highlights the possibility that non-surgical therapies could provide similar pain benefits, as surgery without associated surgical complications in selected patient groups. Further research is required to determine if differing pain phenotypes respond more favorably to specific treatments.