The Long-Term Rate of Reoperation After Midurethral Sling Insertion Among Women With Urinary Incontinence: A Population-Based Study.

INTRODUCTION AND HYPOTHESIS: This study evaluated the reoperation rate and risk factors among women who underwent midurethral sling (MUS) insertion for stress urinary incontinence (SUI). Reoperation was defined as an additional incontinence procedure due to insufficient benefit from the initial MUS, excluding surgeries for mesh-related complications or device removal.

METHODS

We analyzed 221,082 women aged ≥ 20 years who received MUS between 2009 and 2015 in South Korea. Data from the National Health Insurance Service were used to determine reoperation rates, and Cox regression identified independent risk factors.

RESULTS

Reoperation rates were 0.8% at 1 year, 2.7% at 5 years, and 4.8% at 12 years. Younger age (< 60 years) was associated with a higher likelihood of reoperation (hazard ratio [HR] 1.957, p < 0.001). Overactive bladder (HR 2.308, p < 0.001), neurogenic bladder (HR 2.308, p < 0.001), and diabetes were also significant risk factors. However, diagnoses were based on claims data, potentially leading to misclassification. Variability in surgical expertise and evolving medical practices may further limit generalizability.

CONCLUSIONS

Among 221,082 women undergoing MUS, the long-term reoperation rate was 4.8%. Younger age, overactive bladder, neurogenic bladder, and diabetes were key risk factors. Preoperative assessment of these factors is essential for optimizing patient selection.