Login to Access Video or Poster Abstract: MP40-07
Sources of Funding: None

Introduction

The debate regarding the optimal definition of success after sling surgery hinges on the following: is resolution of stress incontinence (SUI) at the expense of urinary retention or worsened urgency incontinence (UUI) preferable to unresolved SUI? Other than postoperative UUI, there is paucity of information regarding reasons behind &[Prime]surgical failure.&[Prime] We aim to evaluate the &[Prime]happy/wet&[Prime] and the &[Prime]unhappy/dry&[Prime] groups of women treated with autologous rectus fascia (ARF), transobturator (TO) and retropubic (RP) midurethral slings.

Methods

This is an IRB approved, retrospective chart review of all women who underwent sling surgery at our institution from 2004 to 2015 with ≥ 12 month follow up (FU). All had SEAPI scoring (stress incontinence, emptying, anatomy, protection, inhibition) and 10 point visual analog score (VAS) of satisfaction. Demographics and perioperative details were abstracted from the office and hospital charts. Cure of SUI equaled: no subjective or objective SUI, and no additional anti incontinence surgery. &[Prime]Dry/unhappy&[Prime] were women with no SUI and VAS < 8. Those with SUI and VAS ≥ 8 were &[Prime]wet/happy&[Prime].

Results

Mean FU was 30 months. Of 1,748 eligible women who underwent sling surgery, 115 (7%) were considered &[Prime]dry/unhappy&[Prime](41 RP; 40 TO; 34 ARF). Incidence of other postoperative symptoms was: 36 (31%) worse or de novo voiding problems, 21 (18%) worse or de novo UUI, 15 (13%) pain, 13 (11%) dyspareunia, and 12 (10%) recurrent prolapse. Additional surgeries during FU period were: 10% sling incision (11 women, 14 incisions), 6% prolapse repair, 5% repeat sling (all dry afterwards), and 4% sling revisions (for pain or extrusion). Several women without objective mesh problems also developed concerns regarding their slings. In the 24 who had sling only, 38% and 25% had worsened voiding and UUI, respectively. There were 201 (11.5%) in the &[Prime]wet/happy&[Prime] group (96 RP; 64 TO; 41 ARF). Postoperative SUI status was: 139 (69%) improved, 13 (6%) de novo, and 9 (4%) worse. Additional surgeries during the FU period were: 6% prolapse repair, 3% bulking, 2% repeat sling, 2% sling revision, and 1% sling incision. In 62 women having sling only, 89% had SUI improvement. Concomitant surgery inversely correlated with satisfaction.

Conclusions

Even if initial cure is not achieved, SUI improvement typically leads to satisfaction after sling surgery. Along with UUI, postoperative pain, prolapse, and voiding problems contribute to dissatisfaction with sling surgery; however, these events are strongly associated with concomitant pelvic surgical procedures. Proper counseling regarding expectations after sling, with or without concomitant surgery, is paramount in improving outcomes and satisfaction.

Funding

None