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. 2020 Apr;31(4):727-735.
doi: 10.1007/s00192-019-04223-1. Epub 2020 Jan 20.

Long-term re-procedure rate after mid-urethral slings for stress urinary incontinence

Sari Tulokas  1 , Päivi Rahkola-Soisalo  1 , Mika Gissler  2   3 , Tomi S Mikkola  1 , Maarit J Mentula  4
Affiliations

Long-term re-procedure rate after mid-urethral slings for stress urinary incontinence

Sari Tulokas et al. Int Urogynecol J. 2020 Apr.

Abstract

Introduction and hypothesis: Long-term safety concerns have risen over the mid-urethral sling operation (MUS) for stress urinary incontinence (SUI), which in some countries has led to litigations and even suspending MUS insertions. We examined the long-term re-procedure rate after MUS operations. The main outcome was re-procedures for SUI. The secondary outcome was surgical interventions due to complications.

Methods: We analysed a retrospective population cohort of 3531 women with MUS operations in 2000-2006 and followed them up until 31 December 2016. Data were collected from a national hospital register and from hospital patient records.

Results: The median follow-up time was 13 years (IQR 11.6-14.8) for the 3280 women with a retropubic MUS (RP-MUS) and 11 years (IQR 10.3-11.9) for the 245 women with a transobturator MUS (TO-MUS). The cumulative number of re-procedures for SUI was 16 (0.5%) at 1 year, 66 (1.9%) at 5 years, 97 (2.8%) at 10 years and 112 (3.2%) at 17 years. This risk was higher after TO-MUS than after RP-MUS operations (OR 3.6, 95% CI 2.5-5.2, p < 0.001). The cumulative number of any long-term re-procedure was 43 (1.2%) at year 1, 105 (3.0%) at year 5, 144 (4.1%) at year 10 and 163 (4.6%) at year 17.

Conclusions: Re-procedures occur up to 17 years after primary MUS insertion, but their incidence is low after the first few postoperative years. Re-procedures for recurrent SUI are more common after TO-MUS than RP-MUS.

Keywords: Mesh tape; Mid-urethral sling; Stress urinary incontinence; TOT; TVT.

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Conflict of interest statement

Tulokas has received research grants from the Finnish Society of Gynaecological Surgery, the Finnish Cultural Foundation and Helsinki University Hospital during the conduct of the study. Rahkola-Soisalo has received funding for congress attendance from Olympus and Astellas Pharma outside the submitted work. Gissler declares that he has no conflict of interest. Mikkola has received personal lecture fees from Astellas and Mylan and unrestricted grant from Contura outside the submitted work. Mentula has received research grants from Finnish Cultural Foundation during the conduct of the study outside the submitted work.

Figures

Fig. 1
Fig. 1
Sample cases obtained from the hospital records and Care Register. MUS mid-urethral sling, Care Register Care Register for Health Care, RP-MUS retropubic mid-urethral sling, TO-MUS trans-obturator mid-urethral sling
Fig. 2
Fig. 2
Survival without re-procedure for SUI (%)
See this image and copyright information in PMC

Comment in

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