Late Presentation of Complications of Mid-Urethral Slings and Outcomes After Sub-Urethral Sling Removal

INTRODUCTION: Mid-urethral slings (MUS) are common procedures for surgical management of stress urinary incontinence (SUI) in women and have recognized complications, which are often underdiagnosed if they occur late and may result in complex care even after sub-urethral sling removal (SSR). This study focused on the evaluation of MUS complications occurring 10+ years after placement, and outcomes after sling release. METHODS: Demographics, past medical history, original MUS operative note, presenting symptoms, pre-SSR evaluation, peri-operative complications, post-SSR symptoms at last visit, were collected from EMR (EPIC) for patients who underwent SSR at least 10 years after MUS placement. For those not seen in the past 2 years, a standardized phone interview using validated questionnaires was performed by a neutral investigator not involved in the care of these patients. RESULTS: From 2006 to 2023, 58 patients met study criteria with mean age of 65 ± 10.5 years and predominantly Caucasian (91%). Nine were reached by phone and 4 were lost to follow-up. Time from initial MUS procedure to SSR removal was 16.7 ± 3.9 years. Most MUS were TVT (76%), followed by TOT (18%). At presentation, 90% of patients reported pain, 86% dyspareunia, 69% recurrent UTI, 52% SUI, and 53% urge urinary incontinence. Multiple presenting symptoms were observed in 83% of patients. At a mean follow-up of 2.2 years, SSR resulted in resolution of pain in 50% of patients, dyspareunia in 50%, recurrent UTI in 60%, SUI in 29%, and urge urinary incontinence in 37%, for each respective initial symptom. Some patients reported de novo pain (3%), UTIs (2%), SUI (9%) or urge urinary incontinence (7%). 7% required subsequent surgery for UI or persistent pain-related issues. CONCLUSIONS: It is important that pelvic reconstructive surgeons monitor patients who receive MUS over time and counsel patients considering MUS on these potential risks.