Patients who had a story of synthetic mid-urethral sling (MUS) may develop complications. Symptoms may include pain, low flow, 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 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. Patients with neuro-bladder damage, pelvic radiotherapy, vaginal mesh implantation for prolapse were excluded. 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 old. MUS were implanted for pure SUI in 64.3 %. Removals were total in 18.6 %, 63.2 % partial. 63.1 % of removal were TOT. Main symptom leading to removal is presented in figure 1. Removals were made for exposure in 51.5 % and for functional causes in 49.5 %. There exist different causes for removal distinguishing MUS type. Before removal pain was found in 49.3 %. At an early postoperative visit only 20.7 % had pain (p<0.05 vs before) with 62.3 % of painful relief. Different pain locations weren't even cured at the same rate. Total removal significantly improved pain cure rate in TOT . 36.1 % and 7.4 % had low flow before and after removal. OAB or urge urinary incontinence were improved only if it was the main symptom leading to removal. Symptoms were stable at late visit. Finally leading symptom for removal were cured in 63.6 % at early visit and 60.5 % at late. Only 23.4 % were totally 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 %, with treatment efficacy in 68.8 %.
Tape removal is effective only in two third of the cases. Patients have to be informed before the surgery. Moreover symptom relief depends on its nature.
Removal in MUS complications shows significant improvement in pain and low flow. However, some patients remain symptomatic after MUS removal and require follow-up. SUI is the main symptom after MUS removal but surgical treatments seem to be effective.
