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

Introduction and hypothesis: Midurethral 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.

Methods: This 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.

Results: Of 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%)).

Conclusions: In 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%.