Endometriosis Is Not Associated With Mesh Excision in a Case-control Study

Caroline Layding, Layding C, Morgan Egnot, Egnot M, Meyn L, Leslie Meyn, Pamela A. Moalli, Moalli PA, Artsen AM, Amanda M. Artsen
Urogynecology (Philadelphia, Pa.) · 2025 · vol. 32(6) , pp. 720–725 · doi:10.1097/spv.0000000000001730 · PMID:42150758 · W7161592562
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This case-control study found that while endometriosis was more common in patients undergoing mesh excision on univariate analysis, it was not a significant predictor after controlling for demographic and clinical factors.

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This unmatched case-control study investigated whether a prior diagnosis of endometriosis serves as a risk factor for the need to excise polypropylene mesh implants. The researchers compared 179 patients who underwent mesh excision due to complications against 65 control patients with uncomplicated mesh implants, using logistic regression to adjust for demographic and clinical variables. Although univariate analysis showed a higher prevalence of endometriosis in the excision group, this association lost statistical significance after controlling for factors such as age, smoking status, body mass index, and implant duration. Relevance to endometriosis: listed as one indication for GnRH antagonists, though the paper's main focus is uterine fibroids.

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Abstract

IMPORTANCE: Like polypropylene mesh complications, endometriosis is characterized by inflammation and pain. Chronic pelvic pain is overrepresented in patients with mesh complications. It is unknown whether endometriosis specifically is a risk factor for mesh excision. OBJECTIVE: The objective of this study was to evaluate whether patients undergoing mesh excision have a higher rate of endometriosis diagnosis than those who heal well after mesh implantation. STUDY DESIGN: We conducted an unmatched case-control study on patients undergoing mesh excision (n=179). Our control group consisted of patients with implanted mesh without complications (n=65). Endometriosis diagnosis was abstracted from charts using a comprehensive definition and pathology reports, where available. Logistic regression was used to evaluate the association between endometriosis diagnosis and mesh excision while controlling for patient factors. RESULTS: Patients underwent excision primarily for pain (29%), mesh exposure (67%), or infection (3%). Patients undergoing excision were younger ( P <0.001), had a higher body mass index ( P =0.002), and were current or former smokers ( P <0.001). Although these patients did have a higher rate of endometriosis on univariate analysis (18.4% vs. 7.7%, 0.046), this was no longer significant when controlling for demographic and clinical factors (adjusted odds ratio [aOR]=2.32; 95% CI: 0.70, 7.70). A 5-year decrease in age (aOR=1.35; 95% CI: 1.16, 1.57), current or former smoker status (aOR=2.75; 95% CI: 1.36, 5.57), body mass index (aOR=1.09; 95% CI: 1.02, 1.18), and duration of implantation (aOR=1.18; 95% CI: 1.07, 1.30) were independently associated with mesh excision. CONCLUSION: Endometriosis diagnosis was not a significant predictor of mesh excision when controlling for other established risk factors.
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Objective

The objective of this study was to evaluate whether patients undergoing mesh excision have a higher rate of endometriosis diagnosis than those who heal well after mesh implantation. Study Design We conducted an unmatched case-control study on patients undergoing mesh excision (n=179). Our control group consisted of patients with implanted mesh without complications (n=65). Endometriosis diagnosis was abstracted from charts using a comprehensive definition and pathology reports, where available. Logistic regression was used to evaluate the association between endometriosis diagnosis and mesh excision while controlling for patient factors.

Results

Patients underwent excision primarily for pain (29%), mesh exposure (67%), or infection (3%). Patients undergoing excision were younger (P<0.001), had a higher body mass index (P=0.002), and were current or former smokers (P<0.001). Although these patients did have a higher rate of endometriosis on univariate analysis (18.4% vs. 7.7%, 0.046), this was no longer significant when controlling for demographic and clinical factors (adjusted odds ratio [aOR]=2.32; 95% CI: 0.70, 7.70). A 5-year decrease in age (aOR=1.35; 95% CI: 1.16, 1.57), current or former smoker status (aOR=2.75; 95% CI: 1.36, 5.57), body mass index (aOR=1.09; 95% CI: 1.02, 1.18), and duration of implantation (aOR=1.18; 95% CI: 1.07, 1.30) were independently associated with mesh excision.

Conclusion

Endometriosis diagnosis was not a significant predictor of mesh excision when controlling for other established risk factors.

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Condition tags

endometriosischronic_pelvic_pain

MeSH descriptors

Device Removal Device Removal Device Removal Device Removal Device Removal Device Removal Device Removal Device Removal Device Removal Device Removal Device Removal Device Removal Device Removal Device Removal Device Removal Device Removal Device Removal Device Removal Device Removal Device Removal

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