Long-Term Outcomes of Midurethral Slings: A Narrative Review of Objective and Patient-Reported Trajectories

Midurethral sling (MUS) procedures are widely used for stress urinary incontinence (SUI), yet long-term outcomes remain incompletely characterized. This narrative review synthesizes evidence from studies with ≥10 years of follow-up, focusing on structural continence, patient-reported outcomes, late complications, and evolving storage symptoms.

A PubMed-based narrative review was conducted for studies published between January 1996 and March 2026 reporting ≥10-year outcomes after MUS. Randomized trials and observational studies were included. Outcomes included subjective and objective continence, reoperation rates, mesh-related complications, de novo overactive bladder (OAB), and quality of life. Given heterogeneity in design and outcome definitions, findings were synthesized qualitatively through thematic grouping, temporal trajectory analysis, and cross-study interpretative comparison.

Seventeen studies with 10-25+ years of follow-up were included. Objective cure rates exceeded 85-90% at 10 years and remained stable in retropubic cohorts. Subjective cure rates were more variable and declined in some cohorts despite preserved objective outcomes. Long-term randomized data suggested comparable continence between retropubic and transobturator slings, although some favored retropubic approaches under stricter definitions. De novo OAB increased over time, reaching 41.6% at 20 years, while transobturator mesh exposure rates increased from 2.5% at 13 years to 10% at 17 years. Patient-reported outcomes appeared increasingly influenced by storage symptoms, particularly de novo OAB, whereas the contribution of voiding dysfunction remained insufficiently characterized in the available literature.

MUS procedures provide durable long-term structural continence. However, patient-perceived outcomes may evolve due to storage symptoms, particularly de novo OAB, and late complications. Although voiding dysfunction may contribute to long-term symptom burden, its role remains insufficiently characterized in the available literature. Longitudinal, domain-specific assessment beyond binary continence measures is needed.