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Title of Journal: Int Urogynecol J

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Abbravation: International Urogynecology Journal

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Springer London

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DOI

10.1007/s00214-015-1648-0

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1433-3023

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Polypropylene mesh slings and cancer An incidenta

Authors: Howard B Goldman Peter L Dwyer
Publish Date: 2015/11/19
Volume: 27, Issue: 3, Pages: 345-346
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Abstract

If polypropylene mesh slings were found to lead to malignancy even in a small number of cases it would lead to clear practice changes The current report describes a case of clear cell carcinoma diagnosed in a patient who was also noted to have an exposed midurethral sling Clear cell carcinoma is a rare tumor that can occur primarily within the urethra or the vagina In the vagina it is often associated with in utero diethylstilbestrol DES exposure while in the urethra the majority of such cancers are associated with a urethral diverticulum The report by Lin et al 1 describes a patient who presented with urinary retention and symptoms of a urinary tract infection UTI who was found upon examination to have mesh exposure in the vaginal fornix and an inflamed and tender anterior vaginal wall She received a transvaginal tape obturator TVTo Gynecare Johnson Johnson Somerville NJ USA 10 years earlier The exposed mesh was excised but within 2 months the vaginal wall was friable ultimately invasive clear cell carcinoma was diagnosedA second patient presented to one of the authors PLD with recurrent UTIs dysuria and a 3cm paraurethral mass 14 months after placement of an Advantage midurethral sling Boston Scientific and native tissue repair had been performed She was diagnosed with squamous cell carcinoma possibly of lower urinary tract or vaginal origin Despite undergoing radical surgery she died of the diseaseWith almost 20 years of commercial availability this is the first published case report of direct proximity of a malignancy to a midurethral polypropylene sling One would expect that if this were a genuine problem we would be seeing more of such cancer cases given the millions of women with these products inserted Of course one might respond that this is the tip of the iceberg and more will appear time will tell but it seems unlikelyPresenting symptoms of the patient reported here—urinary retention—is not consistent with exposed mesh but is more consistent with a rapidly enlarging pelvic tumor She may have had exposed mesh for years and it was only discovered because of her urinary symptomsIn all likelihood this patient had asymptomatic mesh exposure and developed clear cell carcinoma Given the length and breadth of experience with polypropylene midurethral slings it is likely an incidental finding However the possibility of an association has been raised and vigilance is thus required To take this further more than case reports of associations between cancer and the use of polypropylene mesh is needed A significantly increased risk of cancer in women who have these implants must be demonstrated compared with the general population in a large cohort of women On current evidence we believe we should continue to reassure our patients of the low risk of carcinogenicity with polypropylene grafts


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  1. Reply to: The Gräfenberg spot (G-spot) does not exist – a rebuttal of Dwyer PL: Skene’s gland revisited: function, dysfunction and the G spot
  2. Durability of Success after Rectocele Repair
  3. A validated self-administered female pelvic floor questionnaire
  4. A validated self-administered female pelvic floor questionnaire
  5. Risk of postoperative urinary tract infections following midurethral sling operations in women undergoing hysterectomy
  6. Assessment of TVT efficacy in the management of patients with genuine stress incontinence with the use of epidural vs intravenous anesthesia
  7. TVT: On Midurethral Tape Positioning and its Influence on Continence
  8. Duloxetine 1 year on: the long-term outcome of a cohort of women prescribed duloxetine
  9. Single incision mini-sling versus a transobutaror sling: a comparative study on MiniArc™ and Monarc™ slings
  10. Office Assessment of Patient Outcome of Pharmacologic Therapy for Urge Incontinence
  11. Laser welding of vesicovaginal fistula—outcome analysis and long-term outcome: single-centre experience
  12. Outcomes and follow-up after obstetric anal sphincter injuries
  13. Laparoscopic sacral colpoperineopexy: abdominal versus abdominal–vaginal posterior graft attachment
  14. Intrasphincteric injections of autologous muscular cells in women with refractory stress urinary incontinence: a prospective study
  15. Prospective evaluation of outcome of vaginal pessaries versus surgery in women with symptomatic pelvic organ prolapse
  16. Urinary nerve growth factor correlates with the severity of urgency and pain
  17. Related factors of urge, stress, mixed urinary incontinence and overactive bladder in reproductive age womenin Tabriz, Iran : a cross-sectional study
  18. Recurrent pelvic organ prolapse in a woman with bladder exstrophy: a case report of surgical management and review of the literature
  19. The impact of simulated birth trauma and ovariectomy on the gene expression of detrusor muscarinic receptors in female rats
  20. Classification of mesh fiber exposure: comment
  21. The clinical characteristics of female patients with Fournier’s gangrene
  22. Large vesicovaginal fistula in women with pelvic organ prolapse: the role of colpocleisis revisited
  23. Collagen scaffold: a treatment for large mesh exposure following vaginal prolapse repair
  24. Shoulder dystocia and associated manoeuvres as risk factors for perineal trauma
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  26. Important Clinical Outcomes in Urogynecology: Views of Patients, Nurses and Medical Staff
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  28. Incontinence medication response relates to the female urinary microbiota
  29. Short-term natural history in women with symptoms indicative of pelvic organ prolapse
  30. Mixed urinary incontinence—time to uncouple urgency from stress?
  31. The Role of the Levator Ani Muscle in Evacuation, Sexual Performance and Pelvic Floor Disorders
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  33. The Prevalence of Urinary Tract Infections in Patients with Gestational Diabetes Mellitus
  34. Foreword: Sacral nerve stimulation now and in the future
  35. Long-term anatomical and functional assessment of trans-vaginal cystocele repair using a tension-free polypropylene mesh
  36. Incontinence during intercourse: myths unravelled
  37. Fecal incontinence: a review of prevalence and obstetric risk factors
  38. Risk factors for painful bladder syndrome in women seeking gynecologic care
  39. Can 3D power Doppler identify levator ani vascularization at its pubic insertion?
  40. Predictors of outcomes in the treatment of urge urinary incontinence in women
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  44. Effectiveness of intravesical hyaluronic acid/chondroitin sulfate in recurrent bacterial cystitis: a randomized study
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  46. The effectiveness of the sacrospinous hysteropexy for the primary treatment of uterovaginal prolapse
  47. Choice of pelvic organ prolapse surgery: vaginal or abdominal, native tissue or synthetic grafts, open abdominal versus laparoscopic or robotic
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  58. Ureterovaginal fistula: a case series
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  70. Surgery for cystocele III: do all cystoceles involve apical descent?
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