Midurethral Slings for the Treatment of Stress Urinary Incontinence

Abstract

INTRODUCTION: The objective of this study was to report on long-term outcomes after midurethral sling for treatment of stress urinary incontinence (SUI). METHODS: We identified women who underwent midurethral sling procedures (retropubic, transobturator, or mini-slings) from January 1, 2002, through December 31, 2011, at Mayo Clinic, Rochester. The primary outcome was reoperation for recurrent SUI (treatment failure). Patients who had follow-up less than 12 months were excluded. We also reported on reoperation rate for complications. Kaplan-Meier curves were used to calculate the cumulative failure rate and 95% confidence intervals (95% CI). RESULTS: During the study, 1,877 women had a midurethral sling procedure including 1,365 (72.7%) retropubic slings, 254 (13.5%) transobturator slings, and 258 (13.7%) mini-slings. The mean age was 57.9 ± 13.6, 96% were white, median parity was 3 (range, 0 to 9), mean body mass index was 29.9 ± 6.5 kg/m2, and the median follow-up was 10 years (range, 1 to 12 years). The 5-year reoperation rate for stress UI was 4.4% (95% CI 3.4–5.4) (Table 1). There were significantly lower rates of failure among women who underwent the retropubic sling compared with those who had transobturator or mini-sling (P = .002) (Fig. 1). One hundred twelve patients (6%) required surgery as a result of a complication, 89 (6.5%) in the retropubic sling group, 10 (3.9%) in the transobturator sling group, and 13 (5%) in the mini-sling group. These complications were: urinary retention (n = 64), mesh erosion (n = 36), and others (n = 12).CONCLUSIONS: We provide long-term data about risk of reoperation for SUI and complications that can aid preoperative patient counseling.