Analysis of urinary tract infections as a predictor of obstruction in women with a history of urethral sling surgery.

Abstract

Introduction: Midurethral sling (MUS) remains a widely used and effective treatment for stress urinary incontinence, although complications such as voiding dysfunction and urinary tract infections (UTIs) may occur. Prior research has shown that up to 60% of women with chronic lower urinary tract symptoms (LUTS) after MUS surgery meet objective criteria for bladder outlet obstruction (BOO). This exploratory study aimed to assess whether UTI burden is associated with the presence of BOO in women with chronic LUTS following MUS. Secondarily, UTI patterns before and after urethral sling excision were descriptively evaluated.

Methods: A retrospective chart review was conducted examining women with a history of MUS and persistent LUTS for at least six months at a single tertiary care center. Obstruction was assessed using urodynamic studies according to Blaivas criteria or fluoroscopic evidence. UTIs were defined using a combination of culture-positive results and documented symptomatic episodes. Associations between UTI burden and obstruction were evaluated using exploratory regression analyses, and symptom outcomes were assessed before and after sling lysis.

Results: Among 95 patients, 58 (61%) demonstrated urodynamic evidence of obstruction. Across the entire cohort, the median number of UTIs over a two-year period was zero. The proportion of patients with at least one UTI did not differ significantly between obstructed and non-obstructed groups (Fisher's exact test, p=0.80). On exploratory multivariable logistic regression adjusting for age, menopausal status, and diabetes, the association between pre-lysis UTI burden and obstruction was not statistically significant (odds ratio [OR] 1.08, 95% confidence interval [CI] 0.90-1.29, p=0.42). Fifty-seven patients underwent sling lysis. In obstructed patients undergoing lysis, UTI frequency did not change significantly postoperatively (p=0.29), although many patients reported subjective improvement in storage and voiding symptoms.

Conclusions: In this exploratory cohort of women with chronic LUTS following MUS, UTI burden was not observed to be associated with the presence of BOO. While sling excision was associated with subjective symptom improvement, changes in UTI frequency were not statistically significant. These findings suggest that UTI history alone may have limited utility as a clinical marker of obstruction and highlight the need for larger, prospective studies with standardized outcome measures.