Characterization of Lower Urinary Tract Symptoms Before and After Midurethral Sling Revision

To characterize outcomes in women undergoing surgical revision of a midurethral sling and characterize factors associated with satisfaction of revision.

Retrospective cohort study (Canadian Task Force classification II-3).

A urogynecology clinic at a large academic referral center.

Women undergoing surgical revision of synthetic mesh midurethral sling (index surgery).

Chart review was performed to obtain baseline clinicodemographic information, operative notes, urodynamic parameters, and symptom-specific distress and impact questionnaire data. Eligible women were then sent follow-up questionnaires that assessed reasons for index surgery, presence of dyspareunia, symptom-specific distress and impact, and satisfaction after mesh midurethral sling surgery.

Of 144 eligible women, 69 (47.9%) responded, 15 (10.4%) declined participation or were deceased, and 59 (41.6%) did not respond. The mean time from index surgery was 22.2 ± 14.0 months. Women with transobturator slings were more frequently revised for vaginal exposure (p = .003), whereas women with retropubic slings were more frequently revised for voiding dysfunction (p < .0001). Sixty-four percent of women were satisfied with surgery. Satisfied women had more improvement in pain (p = .04), dyspareunia (p < .001), and Patient Global Impression of Improvement questionnaire scores (p < .0001). Multivariable analysis showed that satisfaction decreased with increasing years in age (adjusted odds ratio = 0.95; 95% confidence interval, 0.90-0.99).

Women who were satisfied with sling revision were younger and more likely to have resolution of pain and dyspareunia and improved Patient Global Impression of Improvement scores. This information may help to inform patients regarding expectations with regard to sling revision.