Stress urinary incontinence (SUI) is a common disease amongst women. It is considered a stigmatization and has a major impact on quality of life. Furthermore, the changing demography predicts an increasing number of women developing Urinary incontinence and simultaneously, increasing demand to maintain quality of life at advanced age. 
Simultanously, synthetic polypropylene mesh have been discredited in the last decades due to its morbid adverse events in the widespread utilization for pelvic organ prolapse repair. Consequently, this development put midurethral slings under suspicions and resulted even in the prohibition of midurethral slings in some countries. This development led to the demand for improved quality control mechanisms to ensure the continued use of implants in pelvic organ prolapse and incontinence surgery and additionally, the development of novel implants reducing the burden of foreign bodies particularly polypropylene mesh. 

The current investigation evaluate the performance of retropubic midurethral slings (MUS) in the treatment of female stress urinary incontinence (SUI) in a real-world setting and to identify risk factors for sling failure, particularly the use of partially absorbable slings.

This was a single-center cohort study including women in daily clinical practice, who underwent retropubic MUS procedure for SUI between 2012 and 2019. The follow-up was 12 months. Primary endpoint was cure of SUI assessed by the validated questionnaire International Consultation of Incontinence Questionnaire-Urinary Incontinence-Short Form. Univariate and multivariate analyses were applied to identify risk factors for failure. Wilcoxon signed-rank tests were used as paired samples tests. Univariate and multivariate analyses were performed to identify risk factors for sling failure. The significance level was set at 5%.

A total of 662 women with a median age of 65 (IQR 19) were included in the investigation. 79.0% presented with complicated SUI. 
Cure was reported by 32.2% of the patients. Postoperative urge symptoms, defined by question 4 of the ICIQ-SF, were reported by 312 (47.1%) patients. Adjusted for patients without urge symptoms, cure were reported by 209/350 (60.1%). 
Independent predictors for decreased odds for cure were obesity, pharmacotherapy for overactive bladder, postoperative sling adjustment and the utilization of partially absorbable mesh. The utilization of partially absorbable mesh was associated with a 56% decrease in the odds for achieving cure.

The current investigation emphasizes the impact of the patient heterogeneity in clinical daily practice on the outcome success of midurethral sling procedure. Amongst several risk factors for failure, partially absorbable mesh and the pharmacotherapy of overactive bladder were identified with decreased treatment success. Surgeons should be aware that besides the pharmacotherapy for OAB, women with mixed urinary incontinence may remain significantly affected  by decreased effectiveness of the treatment. Likewise, partially absorbable mesh appear to be rational solution to reduce foreign material and hereby perhaps reducing mesh-related complications. However, the current results question the effectiveness of these slings in clinical practice.

Certified continence center have high heterogeneities in patient population which decrease significantly the odds for cure. Particularly women taking medication for OAB should be informed about the possible reduced risk for cure. Furthermore, the role of partially absorbable mesh for SUI treatment should be evaluated in further prospective trials.