A comprehensive look at risk factors for mid-urethral sling revision surgery



The objective of this study was to identify risk factors and urodynamic parameters predictive of mid-urethral sling (MUS) revision surgery that can be used for counseling patients and individualizing risk prediction.


Retrospective case-control analysis of 40 sling revisions performed during the 12-year study period were compared to 123 control cases that did not require revision to obtain a 1:3 case-to-control ratio. Demographic, perioperative, and urodynamic data were analyzed, with p < 0.05 as significant. Independent predictors of sling revision were assessed by binary logistic regression models, with risk expressed as adjusted odds ratios.


After multiple regression analysis, younger age at time of index MUS placement (aOR 0.93, 95% CI 0.88–0.97), increasing number of cesarean deliveries (CD) (aOR 2.00, 95% CI 1.01–3.96), and concomitant apical prolapse repair during index MUS procedure (aOR 4.63, 95% CI 1.34–15.93) were significant predictors of sling revision.


Young age at the time of placement, multiple CD, and concomitant apical prolapse repair were independent factors predictive of sling revision. Giving consideration to risk factors could improve patient counseling and surgical candidate selection.

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  1. 1.

    Abrams P, Andersson KE, Birder L, Brubaker L, Cardozo L, Chapple C, et al. Fourth international consultation on incontinence recommendations of the international scientific committee: evaluation and treatment of urinary incontinence, pelvic organ prolapse, and fecal incontinence. Neurourology and Urodynamics: Official Journal of the International Continence Society. 2010;29(1):213–40.

    CAS  Article  Google Scholar 

  2. 2.

    Rogo-Gupta L, Litwin MS, Saigal CS, Anger JT, Urologic Diseases in America Project. Trends in the surgical management of stress urinary incontinence among female Medicare beneficiaries, 2002-2007. Urology. 2013;82(1):38–42.

    Article  Google Scholar 

  3. 3.

    Funk MJ, Levin PJ, Wu JM. Trends in the surgical management of stress urinary incontinence. Obstet Gynecol. 2012;119(4):845.

    Article  Google Scholar 

  4. 4.

    Trabuco EC, Klingele CJ, Blandon RE, Occhino JA, Weaver MAL, McGree MME, et al. Burch retropubic urethropexy compared with midurethral sling with concurrent sacrocolpopexy: a randomized controlled trial. Obstet Gynecol. 2016;128(4):828.

    Article  Google Scholar 

  5. 5.

    Palmerola, R., Peyronnet, B., Rebolos, M., Khan, A., Sussman, R. D., Escobar, C., ... & Nitti, V. W. (2019). Trends in Stress Urinary IncontinenceSurgery at a Tertiary Center: Midurethral Sling Use Following the AUGS/SUFU Position Statement. Urology, 131, 71–76.

  6. 6.

    Funk MJ, Siddiqui NY, Pate V, Amundsen CL, Wu JM. Sling revision/removal for mesh erosion and urinary retention: long-term risk and predictors. Am J Obstet Gynecol. 2013;208(1):73–e1.

    Google Scholar 

  7. 7.

    Unger CA, Rizzo AE, Ridgeway B. Indications and risk factors for midurethral sling revision. Int Urogynecol J. 2016;27(1):117–22.

    Article  Google Scholar 

  8. 8.

    Molden S, Patterson D, et al. Risk factors leading to midurethral sling revision: a multicenter case-control study. International Urogynecologic Journal. 2010;21:1253–9.

    Article  Google Scholar 

  9. 9.

    Nager CW, FitzGerald MP, Kraus SR, et al. Urodynamic measures do not predict stress continence outcomes after surgery for stress urinary incontinence in selected women. J Urol. 2008;179:1470–4.

    Article  Google Scholar 

  10. 10.

    Richter HE, Litman HJ, Lukacz ES, et al. Demographic and clinical predictors of treatment failure one year after midurethral sling surgery. Obstet Gynecol. 2011;117:913–21.

    Article  Google Scholar 

  11. 11.

    Sevestre S, Ciofu C, Deval B, et al. Results of the tension-free vaginal tape technique in the elderly. Eur Urol. 2003;44:128–31.

    Article  Google Scholar 

  12. 12.

    Barber MD, Kleeman S, Karram MM, et al. Risk factors associated with failure 1 year after retropubic or transobturator midurethral slings. Am J Obstet Gynecol. 2008(199):666e1–.e.

  13. 13.

    Walsh K, Generao SE, White MJ, Katz D, Stone AR. The influence of age on quality of life outcome in women following a tension-free vaginal tape procedure. American Urologic Assocciation. 2004. https://doi.org/10.1097/01.ju.0000112955.17381.a1.

  14. 14.

    Nilsson CG, Kuuva N. The tension-free vaginal tape procedure is successful in the majority of women with indications for surgical treatment of urinary stress incontinence. Br J Obstet Gynaecol. 2001;108:414–9.

    CAS  Article  Google Scholar 

  15. 15.

    Park J, McDermott CD, Terry CL, et al. Use of preoperative prolapse reduction stress testing and the risk of a second surgery for urinary symptoms following laparoscopic sacral colpoperineopexy. International Urogynecologic Journal. 2012;23:857–64.

    Article  Google Scholar 

  16. 16.

    Barber MD, Kleeman S, Karram MM, et al. Transobturator tape compared with tension-free vaginal tape for the treatment of stress urinary incontinence. Obstet Gynecol. 2008;111(3):611–21.

    Article  Google Scholar 

  17. 17.

    Chai TC, Moalli PA, Richter HE, Lake AG, Kim HY, et al. Preoperative urodynamic parameters (VLPP and MUCP), urinary n-telopeptide (NTx), and plasma vitamin D levels as predictors of midurethral sling surgery outcome. Journal of Urology. 2016.

  18. 18.

    Gleanson JL, Parden AM, Jauk V, et al. Outcomes of midurethral sling procedure in women with mixed urinary incontinence. International Urogynecologic Journal. 2015;26(5):715–20.

    Article  Google Scholar 

  19. 19.

    Nager CW, Sirls L, Litman HJ, et al. Baseline urodynamic predictors of treatment failure 1 year after midurethral sling surgery. J Urol. 2011;186:597–603.

    Article  Google Scholar 

  20. 20.

    Richter HE, Diokno A, Kenton K, et al. Predictors of treatment failure 24 months after surgery for stress urinary incontinence. The Journal or Urology. 2008;179:1024–30.

    Article  Google Scholar 

  21. 21.

    Rodriguez LV, de Almeida F, Dorey F, Raz S. Does valsalva leak point pressure predict outcomes after distal urethral polypropylene sling? Role of urodynamics in the sling era. American Urologic Association. 2004. https://doi.org/10.1097/01.ju.0000132147.56211.4b.

  22. 22.

    Perucchini D, DeLancey JOL, Ashton-Miller JA, et al. Age effects on urethral striated muscle. Am J Obstet Gynecol. 2002;186:351–5.

    Article  Google Scholar 

  23. 23.

    Karateke A, Haliloglu B, Cam C, Sakallu M. Comparison of TVT an TVT-O in patients with stress urinary incontinence: short-term cure rates and factors influencing the outcome. A prospective randomized study. Aust N Z J Obstet Gynaecol. 2009;49:99–105.

    Article  Google Scholar 

  24. 24.

    Jeong SJ, Lee HS, Lee JK, Jeong JW, Lee SC, Kim JH, et al. The long-term influence of body mass index on the success rate of mid-urethral sling surgery among women with stress urinary incontinence or stress-predominant mixed incontinence: comparisons between retropubic and transobturator approaches. PLoS One. 2014;9(11):e113517.

    Article  Google Scholar 

  25. 25.

    Clancy AA, Gauthier I, Ramirez FD, Hickling D, Pascali D. Predictors of sling revision after mid-urethral sling procedures: a case–control study. BJOG Int J Obstet Gynaecol. 2019;126(3):419–26.

    CAS  Article  Google Scholar 

  26. 26.

    Molden S, Bracken J, Nguyen A, et al. A retrospective multicenter study on outcomes after midurethral polypropylene sling revision for voiding dysfunction. Female Pelvic Medicine & Reconstructive Surgery. 2010;16:340–4.

    Article  Google Scholar 

  27. 27.

    Houwert RM, Venema PL, Aquarius AE, et al. Risk factors for failure of retropubic and transobturator midurethral slings. Am J Obstet Gynecol. 2009;201:202.e1-8.

    Article  Google Scholar 

  28. 28.

    Nager CW, Brubacker L, Litman HJ, et al. A randomized trial of urodynamic testing before stress-incontinence surgery. N Engl J Med. 2012;366:1987–97.

    CAS  Article  Google Scholar 

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Correspondence to Melissa Keslar.

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American Urogynecologic Society/ International Urogynecological Association Joint Scientific Meeting: E-Poster, Nashville, TN, September 2019

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Keslar, M., Margossian, H., Katz, J.E. et al. A comprehensive look at risk factors for mid-urethral sling revision surgery. Int Urogynecol J 31, 779–784 (2020). https://doi.org/10.1007/s00192-020-04233-4

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  • Midurethral sling
  • Revision
  • Stress urinary incontinence