The outcomes of women undergoing an incision or excision of midurethral sling mesh

Abstract

Midurethral slings (MUS) are a common treatment for stress urinary incontinence, however in some cases complications require repeat surgery. Our objective was to assess the impact of MUS revision/removal procedures on subjective outcomes and use the validated Urogenital Distress Index questionnaire (UDI-6) to assess longer-term outcomes. We conducted a retrospective review of 48 patients who underwent MUS revision/removal between September 2013 and December 2021. Patients were categorised into three groups: Transection (TVSI), Excision (TVSE), and Complete excision (CSE). UDI-6 scores were collected at 3–6 months post-surgery. We found that de novo stress urinary incontinence occurred in 29%–40% of patients based on the type of mesh revision surgery. Worsening SUI was observed in 19% of TVSE and 40% of CSE patients. De novo urge incontinence was exclusive to TVSE (33%). UDI-6 scores after a median of 2–3 years indicated 25%–38% of patients achieved “asymptomatic” urinary health status, with most of the other women reporting mild to moderate symptoms. Questions on frequent urination and urge incontinence had the highest scores, while voiding dysfunction and pain had the lowest across the three types of MUS revision/removal. These results may help clinicians and patients make informed decisions regarding the treatment of MUS complications.