In surgical treatments of female stress urinary incontinence (SUI), the surgeons' experience and volume of mid-urethral sling (MUS) procedures are known to influence complication risks, but their effect on treatment effectiveness is less clear. In this study we assessed the effect of experience and volume on treatment effectiveness in 34,280 MUS procedures reported to the Norwegian Female Incontinence Registry (NFIR) between 1998 and 2019.
We extracted pre-, per- and postoperative clinical data regarding type of MUS applied, either retropubic or through the transobturator route, ID number of the surgeon, year of surgery, and annual number of surgeries by individual surgeons. Surgeon's experience and volume were defined as having performed </≥ 50 MUS procedures in career and performing 1-10, 11-20 and > 20 procedures per year, respectively. Primary outcomes were objective cure rate defined as no leakage during stress-test, and subjective cure rate as SUI index score <3 at the 6-12-month follow-up. Secondary outcomes were subjective cure rate at 3-year follow-up and satisfied with surgery at 6-12-month and 3-year follow-up. Pearson's chi-square and binary logistic regression were used with separate analyses for tension-free vaginal tape (TVT) and obturator tape (OT).
We found higher objective cure rate among women undergoing TVT procedures performed by experienced and high-volume surgeons, but not for subjective cure rates. Among OT operated women no such associations were found.
We observed a significant but small positive impact of surgeons' experience and annual volume on the objective cure rate after TVT, but not after OT surgery.
International urogynecology journal. 2026 Jun 09 [Epub ahead of print]
Bjørn Holdø, Rune Svenningsen
Department of Obstetrics and Gynecology, Nordland Hospital, Bodø, Norway. ., Department of Obstetrics and Gynecology, Oslo University Hospital, Oslo, Norway.