SUFU 2020: Medium Term Follow-Up of Patient Reported Outcomes Following Complete Removal of Transobturator Midurethral Sling

Scottsdale, Arizona ( This was a retrospective chart review to evaluate early and mid-term outcomes of complete removal of trans-obturator (TOT) mid-urethral sling (MUS) removal by a urologist-orthopedic team. We reviewed complications and patient-reported early medium-term outcomes. 

There were 30 patients who had TOT-MUS removal between 2014 and 2018. The Clavien-Dindo classification and Female National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI) were used accordingly. In December 2018, questionnaires including the International Consultation on Incontinence Questionnaire Urinary Incontinence Short Form (ICIQ-UI SF), the Urogenital Distress Inventory (UDI-6), the Pelvic Floor Impact Questionnaire (PFIQ-7), two questions from the Pelvic Organ Prolapse Incontinence Sexual Questionnaire (PISQ), the Patient Global Impression of Improvement (PGI-I) and three free text questions were sent. Ethics approval had been obtained for this study to continue until five years of post-sling removal with a goal of 50 patients. 

Problems following the index surgery included voiding dysfunction, early mesh exposure and urinary retention with prolonged catheterization at 37%, 27%, and 23% respectively. Fort-seven percent of patients had up to three previous sling interventions. Median time insertion relative to removal was 60 months. Nineteen patients underwent 3D US pre-removal with 12 abnormal studies. The mean length of the sling removed was 16.3 cm. No Clavien-Dindo grade 3 or 4 complications were recorded. At six weeks, pain and quality of life scores improved from 6.7 to 1.95 and 5.6 to 2 respectively (Female NIH-CPSI). Eighty-seven percent of patients filled in the questionnaires with a mean follow-up of 16 months (Table 1). Two-thirds of patients were not sexually active with pain or bowel/bladder incontinence rated highly as impacting on this. One-third were sexually active with a mean rating of 2.55/5 for a frequency of pain during intercourse (five indicating a good rating). In free text questions, 70% of patients reported pain of some type or severity. The majority of patients expressed the sentiment that they were satisfied to have had the mesh removed. 

The authors concluded in this review that complete TOT-MUS removal can be performed safely. However medium-term follow-up shows significant urinary morbidity and ongoing pain precluding and during sexual intercourse.

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Presented by: Eva Fong, MD and Sum Sum Lo, MD, Urology Department, Waitematā District Health Board, Auckland, New Zealand; Andrew Graydon, MD, Pediatric Orthopaedic Department, Starship Children’s Hospital, Auckland, New Zealand

Written by: Bilal Farhan, MD, Assistant Professor, Division of Urology, University of Texas, Medical Branch, Texas; Twitter: @BilalfarhanMD, at the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction Winter Meeting, SUFU 2020, February 25 - 29, 2020, Scottsdale, AZ