Multidimensional outcomes of suburethral synthetic midurethral sling removal

  • Nabeel A. Shakir
  • Connie Wang
  • Nirmish Singla
  • Feras Alhalabi
  • Alana Christie
  • Gary E. Lemack
  • Philippe E. ZimmernEmail author
Original Article



To report multidimensional outcomes encompassing pain, dyspareunia, and recurrent urinary tract infections (UTIs), following suburethral sling removal (SSR) of synthetic midurethral slings (MUS) placed for female stress urinary incontinence.


We reviewed a prospectively maintained, IRB-approved database of women undergoing SSR at our institution. Demographic data, type of sling, and symptoms along with Urogenital Distress Inventory-Short Form (UDI-6) scores both before and after SSR were analyzed. Success was defined using several modalities including patient-reported symptoms (ideal outcome) and UDI-6 questionnaire.


From 3/2006–2/2017, 443 women underwent SSR of which 230 met study criteria with median overall follow-up of 23 months (mean 30 months). 180/230 (78%) patients reported 3 or more symptoms at presentation. Median most recent post-SSR total UDI-6 score was 38 vs. 50 at baseline (p < 0.0001). By UDI-6, 53% of patients achieved success post-SSR. An ideal outcome was attained in 22/230 (10%) patients. A modified outcome allowing for one minimally invasive anti-incontinence procedure and excluding sexual activity classified 112/230 (49%) patients as successes.


While patients with MUS present with multiple symptoms, following SSR, there is sustained improvement in multiple symptom domains, including pain and urinary incontinence. Allowing for minimally invasive anti-incontinence procedures (not inclusive of subsequent suburethral sling), the rate of success was 49%, which was comparable to that derived from UDI-6 scores (53%).


Midurethral sling Sling excision Complication of sling Outcome measure UDI-6 



Midurethral sling


Sub-urethral midurethral sling removal


Urogenital Distress Inventory-Short Form


Urinary incontinence


Urinary tract infection


Author contribution

NAS: protocol/project development, data collection or management, data analysis, and manuscript writing/editing. CW: data collection or management. NS: data collection or management, and data analysis. FA: data collection or management. AC: data analysis. GEL: protocol/project development, and manuscript writing/editing. PEZ: protocol/project development, data collection or management, and manuscript writing/editing.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All the procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee (IRB protocol # 072015-079) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Nabeel A. Shakir
    • 1
  • Connie Wang
    • 1
  • Nirmish Singla
    • 1
  • Feras Alhalabi
    • 1
  • Alana Christie
    • 1
  • Gary E. Lemack
    • 1
  • Philippe E. Zimmern
    • 1
    Email author
  1. 1.Department of UrologyUniversity of Texas Southwestern Medical CenterDallasUSA

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