Long-term Survival of Midurethral Mesh Slings for Women with Stress Urinary Incontinence

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Background and objective: Midurethral sling (MUS) use for stress urinary incontinence (SUI) has declined because of controversies. However, there is little evidence on the long-term prevalence of MUS reoperation. The aim of this study was to examine long-term removal and reoperation rates among women with MUS. Methods: This national retrospective cohort study included all female patients aged ≥18 yr with a first MUS insertion for SUI in all French public hospitals and private practices between January 1, 2013, and September 30, 2022. Patients were followed until January 1, 2023. The primary outcome was the MUS removal rate. Secondary outcomes were new MUS insertion and any other surgery for SUI. Cox regression models were used to assess potential factors associated with MUS removal. Key findings and limitations: The study included 217 326 women with a first MUS insertion. There were 5851 MUS removals and 9521 new MUS insertions. Most removals occurred within the first year (58%). The MUS removal rate was 2.7% at 10 yr. There were fewer removals after transoboturator insertion than after retropubic insertion. Alcohol consumption, smoking, and obesity were associated with MUS reoperation. At 10 yr, the rate of new MUS insertions was 4.5% and the rate of any other surgeries was 2.8%. Conclusions and clinical implications: These findings may help in counseling patients on decision-making for SUI treatment. Patient summary: One treatment option for stress urinary incontinence (SUI) in women is insertion of a mesh sling. We looked at the rates of sling removal and reoperation among women treated for SUI in the French population. We found that after 10 years, only 2.7% of cases needed sling removal, 4.5% needed a new sling inserted without removal of the previous sling, and 2.8% needed another type of surgery. These results will help patients in choosing the correct treatment for SUI.

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