Synthetic mid-urethral sling complications: Evolution of presenting symptoms over time

Introduction: To study the evolution of type of presenting symptoms after mid-urethral sling (MUS) placement relative to the interval between placement and subsequent synthetic sling removal (SSR) for complication(s). Methods: An IRB-approved, prospectively maintained database of women who underwent SSR was retrospectively reviewed for demographics, interval between MUS placement and SSR, history of chronic pain syndromes and recurrent urinary tract infections (RUTI), anti-incontinence and prolapse repairs, and MUS-related symptoms at presentation, including storage dysfunction, voiding dysfunction, RUTI, vaginal pain, non-vaginal pain, mesh exposure, and urinary incontinence (UI). Comparisons were made between patient groups divided into 2 and 4-year intervals to test the hypothesis that there would be higher rates of mesh exposure, pain and/or dyspareunia earlier, but higher rates of RUTI and UI in later groups. Results: Between 2005-2017, 278/435 women met study criteria. Overall, mean number of presenting symptoms per patient was 3.8±1.4 and increased significantly in relation to time since MUS placement (P<0.01). There was a significant difference between number of patients presenting with RUTI (P=0.01), vaginal pain (P=0.03), and UI (P=0.03) between the 2-year groups and a significant difference between number of patients presenting with RUTI (P<0.01), non-vaginal pain (P=0.01) and vaginal pain (P=0.05) between the 4-year groups. Conclusions: In our tertiary care center, women with MUS-related complications presented with multiple symptoms that increased in number over time, with a higher rate of pain complaints in earlier groups but a higher rate of RUTI and UI in later groups.