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Updated: Dec 30, 2025
Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
Long-term re-procedure rate after mid-urethral slings for stress urinary incontinence
Sari Tulokas1, Päivi Rahkola-Soisalo1, Mika Gissler2,3
1Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, PO Box 140, 00029, Helsinki, Finland.
Introduction And Hypothesis:
Long-term safety concerns have risen over the mid-urethral sling operation (MUS) for stress urinary incontinence (SUI), which in some countries has led to litigations and even suspending MUS insertions. We examined the long-term re-procedure rate after MUS operations. The main outcome was re-procedures for SUI. The secondary outcome was surgical interventions due to complications.
Methods:
We analysed a retrospective population cohort of 3531 women with MUS operations in 2000-2006 and followed them up until 31 December 2016. Data were collected from a national hospital register and from hospital patient records.
Results:
The median follow-up time was 13 years (IQR 11.6-14.8) for the 3280 women with a retropubic MUS (RP-MUS) and 11 years (IQR 10.3-11.9) for the 245 women with a transobturator MUS (TO-MUS). The cumulative number of re-procedures for SUI was 16 (0.5%) at 1 year, 66 (1.9%) at 5 years, 97 (2.8%) at 10 years and 112 (3.2%) at 17 years. This risk was higher after TO-MUS than after RP-MUS operations (OR 3.6, 95% CI 2.5-5.2, p < 0.001). The cumulative number of any long-term re-procedure was 43 (1.2%) at year 1, 105 (3.0%) at year 5, 144 (4.1%) at year 10 and 163 (4.6%) at year 17.
Conclusions:
Re-procedures occur up to 17 years after primary MUS insertion, but their incidence is low after the first few postoperative years. Re-procedures for recurrent SUI are more common after TO-MUS than RP-MUS.
Insights
Re-operations for stress urinary incontinence (SUI) after mid-urethral sling (MUS) insertion are uncommon long-term, with most occurring within the first few years. Transobturator MUS procedures showed a higher re-operation rate for SUI compared to retropubic MUS.
Area of Science:
- Urology
- Gynecologic Surgery
- Medical Device Safety
Background:
- Mid-urethral sling (MUS) procedures for stress urinary incontinence (SUI) have raised long-term safety concerns.
- Some countries have seen litigation and suspensions related to MUS insertions, prompting investigations into long-term outcomes.
Purpose of the Study:
- To evaluate the long-term re-procedure rates following mid-urethral sling operations for SUI.
- To compare re-procedure rates for SUI and complications between retropubic MUS (RP-MUS) and transobturator MUS (TO-MUS).
Main Methods:
- Retrospective analysis of 3531 women who underwent MUS operations between 2000 and 2006.
- Data collected from a national hospital register and patient records, with follow-up until December 31, 2016.
Main Results:
- The cumulative re-procedure rate for SUI was 3.2% at 17 years.
- Re-procedures for SUI were significantly higher after transobturator MUS (TO-MUS) compared to retropubic MUS (RP-MUS) (OR 3.6).
- The cumulative rate of any long-term re-procedure reached 4.6% at 17 years.
Conclusions:
- Re-procedures after MUS insertion can occur up to 17 years, but the incidence is low after the initial postoperative period.
- Recurrent SUI re-procedures are more frequent following TO-MUS than RP-MUS procedures.
