Patients who a synthetic mid-urethral sling (MUS) may develop complications. Symptoms may include pain, bladder emptying problems, exposure, bladder overactivity (OAB) and even recurrence of stress urinary incontinence (SUI). These complications may necessitate a removal, a challenging surgery. The SUSTER study is a French multicentric study of synthetic MUS removals in women for medium and long term complications, focusing on the post-operative symptomatic evolution.
A retrospective study named was conducted in 11 specialised centers. Recent ICS 2024 terminology about MUS removal was used. Adult women which underwent MUS removal between 2010 and 2024 were included. Were excluded patients with neuro-baldder damage, pelvic radiotherapy, vaginal mesh implantation for prolapse. Statistical analysis was performed using R version 4.5.
551 patients were included for 705 screened. The average age at removal was 59,9 years. MUS were implanted for pure SUI in 64,3 %. Removals were total in 18,6 %, 63,2 % partial. TOT removed were for 63,1 %. Main symptoms leading to removal are presented inFigure 1. Removals were made for exposure in 51,5 % and for functionnal causes in 49,5 %. It exists different causes for removal distinguising MUS type. Before removal pain was found in 49,3 %. At early postoperative visit only 20,7 % had pain (p<0,05 vs before) with 62,3 % of painful paintents cured. Different pain locations weren't even cured at the same rate. Total removal significativly improved pain cure rate in TOT. 36,1 % and 7,4 % had dysuria befrore and after removal. OAB or urge urinary incontinence were improved only if it was symptom leading to removal. Symptoms were stable at late visit. Finaly leading to removal symptom were persistant in 36,4 % at early visit and 39,5 % at late. Only 23,4 % were totaly asymptomatic (no pain/dysuria/SUI or OAB/UUI) at early and 27,4 % at late visit. TVT were less symptomatic than TOT (68,8% vs 79,4% p<0,05). Post removal SUI rate was 60,5 %, treated in 45,8 %, efficacy in 68,8 %.
Removal in MUS complications shows significant improvement in pain and dysuria. However, some patients remain symptomatic after MUS removal and require follow-up. SUI is the main symptom after MUS removal but surgical treatments seems to be effective.
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