Long-term effectiveness of surgical management for symptomatic bladder outlet obstruction following midurethral sling...

To analyze the long-term effectiveness of surgical techniques in managing suspected symptomatic bladder outlet obstruction (BOO) following midurethral sling (MUS) placement.

A three centers retrospective cohort study was conducted. Fifty-nine patients who underwent revision surgery for suspected symptomatic BOO after MUS placement between 2004 and 2024 were identified. The primary endpoint was the recurrence rate of stress urinary incontinence (SUI).

Clinically, patients presented with acute urinary retention following MUS placement (n=24), isolated voiding symptoms (n=14), voiding symptoms with bladder overactivity (n=7), and recurrent urinary tract infections (n=14). The maximum urinary flow rate (Qmax) was<15mL/s in 69% of cases. Three surgical techniques were performed: early sling loosening (n=14), sling section (n=17), and sling removal (n=28). The overall SUI recurrence rate was 35%, respectively 0%, 24%, and 50% for each technique. The overall iterative intervention rate for recurrent SUI was 20%, respectively 0%, 12%, and 36% for each technique. Persistent symptomatic BOO was observed in two cases after early sling loosening, both requiring subsequent sling removal at 3 and 31 months post-loosening.

Several surgical techniques are available for the management of suspected BOO following MUS placement. Approximately one-third of patients experienced recurrent SUI.