Mid-to-Long term patient-reported improvement after mid-urethral sling surgery: which clinical metrics are most reflective?

INTRODUCTION AND HYPOTHESIS: Stress urinary incontinence (SUI), affecting 20-40 % of women, significantly impairs quality of life. Standard midurethral sling (S-MUS) surgery remains the gold standard treatment. This study aimed to evaluate mid- to long-term patient-reported improvement and clinical outcomes following S-MUS, with a focus on factors influencing patient-reported improvement.

METHODS

This prospective cross-sectional study included 72 women with a history of S-MUS surgery who presented to our gynecology outpatient clinic between January 2018 and April 2019. Participants were categorized as improved or non-improved using the Patient Global Impression of Improvement (PGI-I). Collected data included demographics, quality-of-life questionnaires, urogynecological exam findings, and ambulatory urodynamic monitoring (AUM) during a single voiding cycle.

RESULTS

Among 72 women (26.4 % retropubic; 73.6 % transobturator; 59.7 % with concomitant procedures) with a median 5-year duration since surgery (range, 1-19), 47.2 % reported improvement on PGI-I. Persistent leakage was more common in non-improved than improved participants (89.4 % vs 58.8 %; p = 0.005). Apart from AUM, objective outcomes were comparable. On AUM, detrusor overactivity (48.2 % vs 21.7 %; p = 0.048) and observed urge-incontinence events (82.7 % vs 43.4 %; p = 0.032) were more frequent among non- improved women. Symptom burden was higher in the non- improved group (PFDI-20, UDI-6, OAB-V8, PISQ-12; all p < 0.05).

CONCLUSIONS

Mid- to long-term patient-reported improvement is significantly influenced by the persistence of incontinence symptoms and the degree of bother caused by pelvic floor dysfunction. The observed discrepancies between patient-reported improvement and objective measures highlight the limitations of relying solely on conventional objective evaluations. A more comprehensive approach that incorporates patient-centered assessments is essential to fully understand the success of S-MUS surgery and to address the complex, multidimensional nature of patient-reported improvement.

BRIEF SUMMARY: A comprehensive, patient-centered approach is essential to accurately assess the success of S-MUS surgery and to address the complex, multidimensional factors influencing patient-reported improvement.