Short-term Outcomes of Midurethral Sling at the Time of Apical Suspension

Literature is limited on the success rate of midurethral sling (MUS) placement when it is performed at the time of prolapse repair, and the data that do exist are conflicting.

The objective of this study was to assess the difference in short-term stress urinary incontinence (SUI) treatment outcomes between retropubic midurethral slings (RMUSs) with and without concomitant apical prolapse surgery.

This was a retrospective cohort study of consecutive isolated RMUS placement and RMUS placement with apical prolapse surgery at a single tertiary care center between June 2023 and June 2024. Surgical procedures were performed by 8 board-certified urogynecologists. Apical prolapse procedures included sacrocolpopexy, uterosacral ligament suspension, and sacrospinous ligament fixation. Patients with a history of SUI or prolapse surgery were excluded. Postoperative outcomes were assessed at 3 months. A composite definition of SUI treatment failure was used with patient-reported symptoms, objective SUI on examination, and/or need for retreatment. Assuming treatment failure of 20% following isolated RMUS placement, we calculated that 138 participants per group were needed to detect a 15% difference in SUI treatment failure.

Three hundred seventy-six participants were included. One hundred sixty-one (42%) underwent isolated RMUS placement, and 215 (57%) underwent RMUS placement with apical suspension. Demographics and clinical and surgical characteristics are listed in Tables 1-3. Overall, SUI treatment failure at 3 months was 8.4%, and the rate of treatment failure did not differ between the 2 groups.

Short-term SUI treatment outcomes following RMUS placement were not compromised by concomitant apical prolapse repair.