Detection of biofilms on explanted urinary incontinence slings and their relationship with pain, exposure, or urinary tract complications.

Midurethral slings (MUS) are synthetic mesh implants used to treat stress urinary incontinence in women. Positioned via retropubic or transobturator approaches, they support the mid-urethra to maintain closure during increases in intra-abdominal pressure. Although generally effective, long-term MUS complications have been associated with chronic inflammation, pain, and infection, with explanted slings often showing bacterial colonization. The underlying mechanisms remain unclear, particularly the role of microbial biofilms. We examined the presence and characteristics of biofilms on MUS removed for various complications to better inform clinical management. MUS samples ( IMPORTANCE: Biofilms are common on explanted midurethral slings, but their volume does not predict complications. These findings suggest that bacterial composition and host response, rather than bacterial load, drive mesh-related morbidity. Understanding these factors may improve mesh design and guide strategies to prevent infection and chronic complications.