A comprehensive look at risk factors for mid-urethral sling revision surgery

The objective of this study was to identify risk factors and urodynamic parameters predictive of mid-urethral sling (MUS) revision surgery that can be used for counseling patients and individualizing risk prediction.

Retrospective case-control analysis of 40 sling revisions performed during the 12-year study period were compared to 123 control cases that did not require revision to obtain a 1:3 case-to-control ratio. Demographic, perioperative, and urodynamic data were analyzed, with p < 0.05 as significant. Independent predictors of sling revision were assessed by binary logistic regression models, with risk expressed as adjusted odds ratios.

After multiple regression analysis, younger age at time of index MUS placement (aOR 0.93, 95% CI 0.88-0.97), increasing number of cesarean deliveries (CD) (aOR 2.00, 95% CI 1.01-3.96), and concomitant apical prolapse repair during index MUS procedure (aOR 4.63, 95% CI 1.34-15.93) were significant predictors of sling revision.

Young age at the time of placement, multiple CD, and concomitant apical prolapse repair were independent factors predictive of sling revision. Giving consideration to risk factors could improve patient counseling and surgical candidate selection.