Identification of Modifiable and Non-Modifiable Factors Associated With Mid-Urethral Sling Revision Surgery [40S]

Abstract

INTRODUCTION: The objective of this study was to identify modifiable factors and urodynamic parameters predictive of mid-urethral sling (MUS) revision surgery that can be used for counseling patients and individualizing risk prediction. METHODS: Retrospective analysis of 56 sling revisions performed during the 12-year study period. Those with complete medical records (n=40) were matched to 123 control cases that did not require revision, randomly selected from a total of 946 procedures to obtain a 3:1 control: case ratio. Demographic, history, patient reported symptoms, urodynamic study results, intraoperative data, and post-operative data were collected. RESULTS: Significant demographic findings predictive of sling revision included younger age (52.95 vs. 64.48 years, p<0.001) and greater than two previous cesarean deliveries (OR 13.556, 95% CI 1.468-125.137, p=0.013). Presence of posterior pelvic organ prolapse (OR 0.302, 95% CI 0.163-0.803, p=0.011), retropubic sling (OR 2.685, 95% CI 1.037, 6.955, p=0.037) and concomitant apical prolapse repair procedure (OR 3.086, 95% CI 1.299-7.332, p=0.009) was significantly associated with the revision group. Urodynamic factors were not predictive, except a maximum urethral closure pressure less 40 cm H2O was found to be protective (OR 0.0394, 95% CI 0.159-0.978). After multiple regression analysis, younger age, increasing number of cesarean deliveries, and concomitant apical prolapse repair retained statistical significance. CONCLUSION: Urodynamic studies were not useful in determining revision risk as compared to patient age, previous surgical history, and concomitant procedures.