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MIDURETHRAL SLINGS

COMPLICATION RATES
REOPERATION RATES - A large retrospective study of women in England who underwent MUS at NHS hospitals between 2006-2015 included 95 057 women, of which 60 194 had retropubic insertion and 34 863 with transobturator insertion. At median f/u of 5.5 years, the rate of midurethral mesh sling removal was 1.4% at 1yr, 2.7% at 5 yrs, and 3.3% at 9 yrs. The 9-year removal risk after transobturator was 2.7% vs. 3.6% after retropubic insertion. The rate of reoperation for stress urinary incontinence was 1.3% at 1yr, 3.5% at 5yrs, and 4.5% at 9yrs. The rate of any reoperation, including mesh removal, was 2.6% at 1yr, 5.5% at 5yrs, and 6.9% at 9yrs.(1)  Another retrospective study found increased reoperation rates for transobturator vs. retropubic (5.2% vs. 11.2%) but higher intraoperative complications in retropubic vs. transobturator (13.7% vs. 4.7%).  (2) 

URINARY TRACT INFECTION - One study of 9,022 MUS found 2.6% UTI rate within first 30 days of surgery. (4)


TRANSOBTURATOR VS. RETROPUBIC
A systemic review and meta-analysis found that in studies of "high risk  for recurrent SUI, "the objective and subjective cure rate was superior in midurethral with OR of 3.3 and 2.0 ,respectively. Patients high risk include elevated BMI, ISD, POP and persistent, recurrent or refractory SUI. (3)

SLING vs. BURCH
An observational study found overall the continence rates were lower in the Burch urethropexy group than in the fascial sling group (p=0.002). The continence rates at 5 years were 24.1% vs 30.8%, respectively. (5)

SLING EROSION SURGERY
A study of 360 women found 19% of women after mesh sling removal had incontinence with about 80% of these treated successfully with 50% bulking and 50% physical therapy. (6)



​
  1. Gurol-Urganci, Ipek, et al. "Long-term Rate of Mesh Sling Removal Following Midurethral Mesh Sling Insertion Among Women With Stress Urinary Incontinence." JAMA 320.16 (2018): 1659-1669.
  2. Trabuco, E. C., Carranza, D., Nashar, S. A. E., Weaver, A. L., McGree, M. E., Elliott, D. S., … Klingele, C. J. (2019). Reoperation for Urinary Incontinence After Retropubic and Transobturator Sling Procedures. Obstetrics & Gynecology, 1.​
  3. Kim, Aram, et al. “Retropubic versus Transobturator Mid Urethral Slings in Patients at High Risk for Recurrent Stress Incontinence: A Systematic Review and Meta-Analysis.” The Journal of Urology, vol. 202, no. 1, 2019, pp. 132–142.
  4. Vigil, Humberto R., et al. “Risk Factors for Urinary Tract Infection Following Mid Urethral Sling Surgery.” The Journal of Urology, vol. 197, no. 5, 2016, pp. 1268–1273.
  5. Brubaker, L., et al. "5-year continence rates, satisfaction and adverse events of burch urethropexy and fascial sling surgery for urinary incontinence." The Journal of urology 187.4 (2012): 1324-1330.
  6. ​Singla, Nirmish, et al. "Management of urinary incontinence following suburethral sling removal." The Journal of urology 198.3 (2017): 644-649.


  7. ​
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