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.