Which are common contraindications to midurethral sling procedures?

• A. Active urinary tract infection
• B. Pregnancy in the current pregnancy
• C. Poor tissue quality or planned pelvic floor surgery interfering
• D. All of the above

Answer: (D)

Midurethral sling procedures should be avoided when conditions around infection, pregnancy, or pelvic tissue integrity would jeopardize safety or success. An active urinary tract infection around the time of surgery is a clear contraindication because operating with an infection raises the risk of postoperative complications and may worsen the infection; the standard approach is to treat the infection first and delay the sling. Current pregnancy is another contraindication because continence status and pelvic tissues are dynamic during pregnancy, and there isn’t robust evidence supporting safety or effectiveness of the sling in this setting; most surgeons defer until after delivery. Poor tissue quality, such as fragile or scarred pelvic tissues, or plans for other pelvic floor surgeries that would interfere with sling placement or outcome, also argues against performing the procedure due to higher risks of erosion, mesh-related complications, or altered pelvic dynamics. Taken together, all of these scenarios represent reasons not to proceed, so all of the above are common contraindications.