Stress Urinary Incontinence Surgery Outcomes: A 6-Year Review

Abstract

Study Objective A variety of surgical procedures exist to correct stress urinary incontinence (SUI). Mid-urethral slings are currently considered the gold standard. Recent FDA warnings regarding mesh use in pelvic organ prolapse surgeries may have caused negative perceptions towards mesh-based procedures. The objective of this study is to review the outcomes and complications associated with the different surgical procedures performed for SUI. Design A retrospective chart review of patients undergoing SUI surgery from 2013–2018 was performed and included: Mid-urethral sling (MUS), laparoscopic polypropylene mesh sling (Lap mesh sling), laparoscopic Burch (Burch) and autologous fascial sling (AFS). Setting Tertiary care academic center. Patients or Participants Patients were identified from our center's operating room database and verified with office charts from the involved 6 surgeons. Interventions N/A Measurements and Main Results Patient demographics, pre/intra/post-operative measures and surgical outcomes (up to 2 years post-surgery) were reviewed. Of 649 charts, 32% (209/649) had MUS, 31% (200/649) had lap mesh sling, 25% (161/649) had Burch and 12% (79/649) had AFS. 408/649 (62.9%) had concomitant procedures with the most common being posterior vaginal repair (274/408). Intra/post-surgical complication rates were: DVT/PE (0/649), transfusion (0/649), re-operation for hemorrhage (2/649), bladder injury (9/649), bowel injury (4/649), readmission (32/649). Post-op urinary retention rates (and mean duration of catheter use) were: MUS 22.5% (8.4 days), Lap mesh sling 52.0% (11.2 days), Burch 61.5% (5.7 days) and AFS 93.7% (15.9 days). Overall, 232/649 (35.7%) and 124/649 (19%) had information available for the 1- and 2-year follow-up visits. At 1-year post-operatively, SUI was cured in 89% (79/89) of MUS, 82% (63/77) of Lap mesh sling, 92.0% (23/25) of Burch and 58.5% (24/41) of AFS. Conclusion The 2 most common surgical procedures for SUI at our center involve the use of permanent mesh: MUS and laparoscopic mesh sling. Overall, there are low complication rates and good 1-year cure rates for all surgeries except AFS.