Current controversies regarding oncologic risk associated with polypropylene midurethral slings.

for this article http://dx.doi.org/10.1016/j.juro.2015.04.014 available at http://jurology.com/ Editorial Comment: This may seem to be a trivial article. However, with the multiple legal controversies currently surrounding the use of synthetic materials for correction of pelvic floor abnormalities and stress urinary incontinence, the question has been raised, due to results based on rodent studies, as to whether an association exists between mesh placement and subsequent devel- opment of malignancy. Even the suggestion of this would make defense of the use of mesh in a courtroom more difficult. These authors have researched the original literature on which this possible association is based, regarding sarcoma formation after subcutaneous implantation of sheets of polypropylene. They cite literature suggesting that this risk is related to the shape and surface area of the material rather than the composition of the material. They state, "There have thus far been no reports of malignancy in humans after polypropylene mesh placement." Their article concerns specifically mid urethral synthetic slings, reviewing the literature and finding 1 case of a benign inflammatory myofibroblastic tumor that developed in the bladder 10 weeks after tension-free vaginal tape sling placement. Certain factors such as lack of intraoperative or postoperative entry of the mesh into the bladder and the temporal association make causation unlikely. The authors also discuss the fact that the material safety data sheet for polypropylene in its raw form contains a warning regarding sarcoma formation and the statement that this material should not be implanted in humans. The authors cite another review in which concerns about the material safety data sheet were addressed and quote statements regarding these safety data sheets as providing information "relevant to the production workers involved in early manufacturing steps" and not being "for general consumer use or as a product design document." 1 There have been no reports of malignancy in humans in association with mid urethral slings. It would seem that a similar data sweep should be made for different types of mesh used in the repair of pelvic floor prolapse as well.