Persistent or Recurrent Urinary Incontinence 8 Years After Midurethral Sling Surgery: A Retrospective Cohort Study

Introduction and HypothesisMidurethral sling (MUS) surgery improves the quality of life of women with stress urinary incontinence (SUI). Nonetheless, treatment can fail leaving some women who still suffer from urinary incontinence post-surgery. This study determines the prevalence of persistent or recurrent urinary incontinence 8 years after MUS surgery and describes the type and effectiveness of additional treatments.MethodsThis retrospective cohort study is a long-term follow-up study on women who participated in a randomized controlled trial (RCT) on the value of urodynamics and who underwent MUS surgery (VUSIS-2 study). Data were collected through medical file review in 12 of 30 recruiting hospitals, representing 68.2% of inclusions. Data on postoperative symptoms, additional diagnostics and treatments were collected.ResultsOf 578 VUSIS-2 participants, 301 (52.1%) medical files were analysed. Urinary incontinence symptoms were reported in 71 cases (23.6% [95% CI 19.1-28.7]) over a median follow-up of 7.8 years. SUI symptoms were reported in 38 patients (12.6%), including 18 patients (6.0%) [95% CI 2.6-9.3]) with persistent and 20 patients (6.6%) [95% CI 3.1-10.1] with recurrent SUI. Urgency urinary incontinence was reported in 51 medical files (16.9%) [95% CI 11.9-21.6], whereof 18 patients had mixed urinary incontinence complaints. Additional treatment was received in 42 patients (59.2% of incontinent cases [95% CI 47.5-69.8]), of whom nine (3.0%) received additional surgery (3 excisions/removals (1.0%) and two additional MUS placements (0.7%)).ConclusionsIn this retrospective long-term follow-up study among women receiving MUS surgery for predominant SUI, postoperative urinary incontinence symptoms were reported in nearly a quarter of cases. One-third of these women did not receive additional treatment. The prevalence of repeat surgery was 5.6%.