Discussion
The overall 5-year rate of
surgical complications after midurethral sling surgery was 4.7% in our
study. The univariable analyses identified several factors that
potentially place patients at risk of experiencing surgical
complications after midurethral sling surgery, including
older age, menopausal syndrome,
OAD medication, HRT, slower AFR and longer voiding time. In the
multivariable Cox proportional hazards analyses, menopausal syndrome or
HRT was significantly associated with an almost two-fold increased risk
of 5-year surgical complications (i.e., urinary retention or secondary
surgery) after midurethral sling surgery. The association between
menopausal syndrome or HRT remained significant in the subgroup of
patients aged ≤65 years.
Surgical
Complications Following Midurethral Sling Surgery
A global review of epidemiological research on SUI that included studies
published between January 1980 and October 2002 reported a median
prevalence of female UI of 27.6%, most commonly caused by stress
(50%).3 Population-based prevalence rates of SUI
among Chinese women range from 6.7% to 44%,30 while
one Taiwanese study has reported a prevalence of 18.0% based on
patients’ perceptions.31
Midurethral sling surgery is the current gold standard worldwide for SUI
surgery; however, concerns surround mesh-related adverse events
associated with the midurethral sling. One retrospective cohort study
that identified 188,454 eligible women who underwent an index sling
surgery showed that the 9-year risk of sling revision/removal was
relatively low at 3.7%, with a 9-year risk of 1.3% (95% CI, 1.2–1.4)
for urinary retention and the majority occurred within 4 years after the
surgery.32 Similarly, in our study, a relatively low
proportion of patients (4.7%) developed surgical complications within 5
years of undergoing midurethral surgery.