Midurethral sling insertion has revolutionized the management of stress urinary incontinence (SUI) in women, offering a minimally invasive and effective solution. However, despite its widespread adoption, concerns persist regarding the durability and long-term outcomes of this surgical intervention. This study endeavors to bridge the gap in knowledge surrounding the enduring effects of midurethral sling insertion by conducting a comprehensive evaluation of reoperation rates and associated risks among women who have undergone this procedure for SUI.

A robust cohort comprising 221,082 women aged 20 years and above, who underwent mid-urethral sling insertion for SUI between 2009 and 2015, was meticulously analyzed. Over a minimum follow-up period of 6 years, patients were diligently monitored to assess the incidence of reoperations. Leveraging data sourced from the National Health Claims Database of the National Health Insurance Service (NHIS) in Korea, our study meticulously scrutinized the long-term outcomes of midurethral sling insertion in real-world clinical settings. Employing multiple Cox regression analysis, we aimed to identify potential risk factors predisposing women to SUI reoperation, thus offering valuable insights into the determinants of treatment success and failure in this cohort.

Our findings shed light on the trajectory of reoperation rates following midurethral sling insertion, revealing a nuanced pattern over time. Notably, reoperation rates were modest at initial follow-up intervals, with 0.8% at 1 year and 2.7% at 5 years post-surgery. However, a gradual increase was observed with longer-term monitoring, reaching 4.6% at 10 years and 4.8% at 12 years. Multivariate analysis unearthed several key factors associated with an augmented risk of reoperation. Younger age, particularly below 60 years, emerged as a significant predictor, underlining the importance of age-specific considerations in treatment planning. Moreover, the presence of voiding dysfunctions such as overactive bladder and neurogenic bladder, along with a medical history of diabetes, constituted substantial risk factors for heightened rates of SUI reoperation.

In conclusion, our study provides crucial insights into the long-term outcomes of midurethral sling insertion for SUI in women. By delineating the trajectory of reoperation rates and elucidating associated risk factors, we empower clinicians and patients alike to make informed decisions regarding surgical management options. These findings underscore the imperative of personalized approaches tailored to individual patient characteristics, with due consideration of age, comorbidities, and voiding dysfunction profiles.

Armed with this knowledge, clinicians can optimize treatment strategies to mitigate the risk of reoperation and enhance the overall efficacy and durability of midurethral sling insertion for SUI.

Continence 12S (2024) 101478
DOI: 10.1016/j.cont.2024.101478