{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T06:58:14Z","timestamp":1780469894816,"version":"3.54.1"},"reference-count":26,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2021,10,5]],"date-time":"2021-10-05T00:00:00Z","timestamp":1633392000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000682","name":"Royal College of Obstetricians and Gynaecologists","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000682","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2022,3]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To compare the incidence of systemic conditions between women who had surgical treatment for stress incontinence with mesh and without mesh.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>National cohort study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>English National Health Service.<\/jats:p><\/jats:sec><jats:sec><jats:title>Population<\/jats:title><jats:p>Women with no previous record of systemic disease who had first\u2010time urinary incontinence surgery between 1 January 2006 and 31 December 2013, followed up to the earliest of 10\u2009years or 31 March 2019.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Competing\u2010risks regression was used to estimate hazard ratios (HR), adjusted for patient characteristics, with HR\u2009&gt;\u20091 indicating increased incidence following mesh surgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>First postoperative admission with a record of autoimmune disease, fibromyalgia or myalgic encephalomyelitis up to 10\u2009years following the first incontinence procedure.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The cohort included 88\u2009947 women who had mesh surgery and 3389 women who had non\u2010mesh surgery. Both treatment groups were similar with respect to age, socio\u2010economic deprivation, comorbidity and ethnicity. The 10\u2010year cumulative incidence of autoimmune disease, fibromyalgia or myalgic encephalomyelitis was 8.1% (95% CI 7.9\u20138.3%) in the mesh group and 9.0% (95% CI 8.0\u201310.1%) in the non\u2010mesh group (adjusted HR 0.89, 95% CI 0.79\u20131.01; <jats:italic>P<\/jats:italic>\u2009=\u20090.07). A sensitivity analysis including only autoimmune diseases as an outcome returned a similar result.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>These findings do not support claims that synthetic mesh slings cause systemic disease.<\/jats:p><\/jats:sec><jats:sec><jats:title>Tweetable abstract<\/jats:title><jats:p>No evidence of increased risk of systemic conditions after stress incontinence treatment with a mesh sling.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.16917","type":"journal-article","created":{"date-parts":[[2021,9,15]],"date-time":"2021-09-15T15:52:18Z","timestamp":1631721138000},"page":"664-670","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Impact of a mid\u2010urethral synthetic mesh sling on long\u2010term risk of systemic conditions in women with stress urinary incontinence: a national cohort study"],"prefix":"10.1111","volume":"129","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6824-578X","authenticated-orcid":false,"given":"P","family":"Muller","sequence":"first","affiliation":[{"name":"London School of Hygiene &amp; 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Tropical Medicine London UK"},{"name":"Royal College of Obstetricians and Gynaecologists London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4519-6903","authenticated-orcid":false,"given":"S","family":"Jha","sequence":"additional","affiliation":[{"name":"British Society of Urogynaecology London UK"},{"name":"Sheffield Teaching Hospitals Sheffield UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,10,5]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.1991.tb02903.x"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMcp0707023"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.g4531"},{"key":"e_1_2_6_5_1","volume-title":"Urinary Incontinence and Pelvic Organ Prolapse in Women: Management","author":"National Institute for Health and Care Excellence (NICE)","year":"2019"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.325.7355.67"},{"key":"e_1_2_6_7_1","volume-title":"Considerations about Surgical Mesh for SUI","author":"U.S. Food & Drug Administration","year":"2019"},{"key":"e_1_2_6_8_1","volume-title":"Patient Admitted Care, England","author":"NHS Digital, Hospital Episode Statistics","year":"2019"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.j5515"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-020-04407-0"},{"key":"e_1_2_6_11_1","unstructured":"CumberlegeJFirst do no harm: the report of the Independent Medicines and Medical Devices Safety Review. 2020.https:\/\/www.immdsreview.org.uk\/Report.html"},{"key":"e_1_2_6_12_1","volume-title":"Government Announces Strict Rules for the Use of Vaginal Mesh","author":"Department of Health and Social Care","year":"2018"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.21037\/tau.2017.04.06"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)32572-7"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-017-11821-w"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.14997"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2016.12.021"},{"key":"e_1_2_6_18_1","volume-title":"Office of Population Censuses and Surveys Classification of Interventions and Procedures Version 4.7 (OPCS\u20104)","author":"National Health Service","year":"2017"},{"key":"e_1_2_6_19_1","volume-title":"International Statistical Classification of Diseases and Related Health Problems \u2010 10th Revision (ICD\u201010)","author":"World Health Organisation","year":"2011"},{"key":"e_1_2_6_20_1","volume-title":"Measuring Multiple Deprivation at the Small Area Level: The Indices of Deprivation","author":"Department of the Environment Transport and the Regions","year":"2000"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.6930"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1080\/01621459.1999.10474144"},{"key":"e_1_2_6_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/sim.4067"},{"key":"e_1_2_6_24_1","volume-title":"Health Cover UK Market Report","author":"LaingBuisson","year":"2016"},{"key":"e_1_2_6_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaut.2009.09.008"},{"key":"e_1_2_6_26_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10029-017-1591-1"},{"key":"e_1_2_6_27_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11845-019-02008-5"}],"container-title":["BJOG: An International Journal of Obstetrics &amp; 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