E-Posters-Identification of Modifiable and Non-modifiable Factors Associated with Mid-Urethral Sling Revision Surgery

Identification of Modifiable and Non-modifiable Factors Associated with Mid-Urethral Sling Revision Surgery - Melissa Keslar, DO

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Mid-urethral sling (MUS) revision is a relatively common procedure, with up to 3.7% of patients undergoing revision surgery. This study aimed to identify the risk factors associated with MUS revision by examining patient demographics, symptoms, physical findings, and intraoperative data.<br /><br />The study was a retrospective cohort study that compared 45 MUS revision cases with 123 uncomplicated MUS control cases. Several risk factors were identified:<br /><br />1. Demographics: Younger patient age at the time of MUS placement was found to be a significant predictor of revision. Patients who had multiple previous cesarean deliveries also had a higher likelihood of requiring revision.<br /><br />2. Pre-sling symptoms: Patients with pre-sling dyspareunia (pain during sexual intercourse) were more likely to need MUS revision. On the other hand, patients reporting symptoms of urge incontinence, incomplete emptying of the bladder, or nocturia (excessive urination at night) were less likely to require revision.<br /><br />3. Pre-sling physical exam: The presence of apical and anterior prolapse (abnormal positioning of pelvic organs) at the pre-sling exam did not significantly differ between those who required revision and those who did not. However, patients with posterior prolapse had a lower rate of revision.<br /><br />4. Intraoperative factors: Retropubic sling placement was found to increase the likelihood of revision. However, concomitant hysterectomy (removal of the uterus) and posterior prolapse repair were associated with a decreased risk of subsequent sling revision.<br /><br />The study also found that a mid-urethral closing pressure >35 cmH2O prior to MUS placement was a significant risk factor. This parameter was the only urodynamic finding that showed a significant association with MUS revision.<br /><br />In conclusion, younger patient age, multiple previous cesarean deliveries, pre-sling dyspareunia, and retropubic sling placement were identified as risk factors for MUS revision. Conversely, concomitant hysterectomy and posterior prolapse repair were associated with a reduced risk of revision. Understanding these risk factors can help clinicians identify patients who may benefit from closer monitoring or alternative treatment options.

Keywords

Mid-urethral sling revision

Risk factors

Patient demographics

Pre-sling dyspareunia

Retropubic sling placement

Concomitant hysterectomy

Posterior prolapse

Urodynamic finding

Reduced risk

Alternative treatment options