A comprehensive look at risk factors for mid-urethral sling revision surgery
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ORIGINAL ARTICLE
A comprehensive look at risk factors for mid-urethral sling revision surgery Melissa Keslar 1
&
Haroutyoun Margossian 1 & Justin E. Katz 1 & Nisha Lakhi 1,2
Received: 29 September 2019 / Accepted: 20 January 2020 # The International Urogynecological Association 2020
Abstract Introduction The objective of this study was to identify risk factors and urodynamic parameters predictive of mid-urethral sling (MUS) revision surgery that can be used for counseling patients and individualizing risk prediction. Methods Retrospective case-control analysis of 40 sling revisions performed during the 12-year study period were compared to 123 control cases that did not require revision to obtain a 1:3 case-to-control ratio. Demographic, perioperative, and urodynamic data were analyzed, with p < 0.05 as significant. Independent predictors of sling revision were assessed by binary logistic regression models, with risk expressed as adjusted odds ratios. Results After multiple regression analysis, younger age at time of index MUS placement (aOR 0.93, 95% CI 0.88–0.97), increasing number of cesarean deliveries (CD) (aOR 2.00, 95% CI 1.01–3.96), and concomitant apical prolapse repair during index MUS procedure (aOR 4.63, 95% CI 1.34–15.93) were significant predictors of sling revision. Conclusions Young age at the time of placement, multiple CD, and concomitant apical prolapse repair were independent factors predictive of sling revision. Giving consideration to risk factors could improve patient counseling and surgical candidate selection. Keywords Midurethral sling . Revision . Stress urinary incontinence
Introduction An estimated 44–51% of women are affected by urinary incontinence, and half of those have stress urinary incontinence (SUI) [1]. The mid-urethral sling (MUS) has been established as the standard surgical treatment for SUI [1, 2]. It is favored for its convenience, durability, and patient satisfaction [3, 4], resulting in 60–87.2% of all incontinence procedures being MUS [5]. However, data have American Urogynecologic Society/ International Urogynecological Association Joint Scientific Meeting: E-Poster, Nashville, TN, September 2019 Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00192-020-04233-4) contains supplementary material, which is available to authorized users. * Melissa Keslar [email protected] 1
Department of Obstetrics and Gynecology, Richmond University Medical Center, 355 Bard Avenue, Staten Island, NY 10310, USA
2
New York Medical College, Valhalla, NY, USA
shown that up to 3.7% of patients who have undergone MUS will undergo a second procedure for sling revision [6] for reasons such as urinary retention, voiding dysfunction, recurrent urinary tract infection, mesh erosion, vaginal pain/dyspareunia, and groin pain [7]. Several investigators have examined and analyzed demographics, medical and surgical history, and type of sling placement as possible risk factors for MUS revision surgery. Many studies have considered age at the time
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