Synthetic midurethral slings (MUS) remain the gold standard surgical treatment of SUI (stress urinary incontinence) in female patients. MUS can be associated with early and late postoperative complications, that can be highly burdensome, and may require surgical revision. Several surgical techniques for sling revision have been described but no consensus have been found so far on the best technique to use. Sling revision leads to a risk of SUI recurrence, yet this risk remains unclear.
The purpose of this study was to report the rate of SUI recurrence after sling revision and to determine predictive factors of SUI recurrence.

We conducted a retrospective cohort study in a single academic center between 2005 and 2022, of patients who underwent sling revision. Four surgical techniques were used for sling revision: sling loosening, sling section, partial excision and total excision. The indication for sling revision were categorized as: voiding dysfunction, urethral or bladder extrusion, pain or vaginal exposure. The primary endpoint was recurrence of stress urinary incontinence at 3 months postoperatively, and the other outcome of interest was the rate of subsequent anti-incontinence surgical procedure.

69 patients were included for analysis. Stress urinary incontinence recurred in 46% of patients within 3 months following sling revision. Fifteen patients underwent a subsequent anti-incontinence procedure (21.8%). The time to revision was significantly longer in the group with recurrent SUI (median: 84.5 vs 44.8 months; p=0.004). The recurrence rate differed significantly depending on the revision technique: 7.7% after sling loosening, 22.2% after sling section, 60% after partial excision and 66.7% after complete sling removal (p=0.001). The risk of SUI recurrence was lower for those whose indication of reoperation was voiding dysfunction (27.3% vs. 66.7%; p=0.002), and was higher for those who underwent a TOT rather than a TVT revision (68.4% vs. 35.7%; p=0.02). In multivariate analysis, only the revision technique remained significantly associated with the risk of recurrence of SUI (complete excision vs section: OR=4.66; p=0.04).

The decision to perform sling revision is a trade-off between alleviating complication symptoms and the risk of SUI recurrence. About half of the patients experience SUI recurrence after MUS revision. However, this risk may differ widely according to the technique used for sling revision, it seems that the less extensive the surgical procedure is, the lower is the risk of SUI recurrence. We believe this finding may impact significantly patients’ counseling prior to sling revision.

About half of the patients may have SUI recurrence after sling revision. The sling revision technique may be the strongest determinant of the risk of SUI recurrence. Further studies are needed to refine this finding and shed light on how the extent of sling dissection and removal may impact the risk of SUI recurrence but also the success of the revision.