Results
We identified 1,961 women with SUI who underwent first-time midurethral sling surgery between 2003 and 2018 in CMUH, with a median age of 53.5 years (IQR, 46.4–64.0; Table 1 ). Surgical complications (i.e., secondary surgery and urinary retention) occurred in 93 (4.7%) patients within 5 years following the index operations.
Patients with surgical complications were more likely to be older (60.3 years vs 53.1 years), to have a history of menopausal syndrome within 1 year prior to the index operation (16.1% vs 9.6%), a medication history of oral antidiabetic drug (OAD; 8.6% vs 3.9%), HRT (32.3% vs 13.7%), slower AFR (8.0 ml/s vs 10.0 ml/s), and longer voiding time (45.4 s vs 33.0 s), compared with patients without 5-year surgical complications,.
We used multivariable Cox proportional hazard modeling to investigate the risk factors associated with 5-year surgical complications (Table 2 ). After including age, diabetes mellitus, duration of surgery, menopausal syndrome or HRT, AFR, and sling type in the full model, only menopausal syndrome or HRT (adjusted HR, 1.794; 95% CI, 1.055–3.050, p=0.0390) remained significantly associated with the risk of 5-year surgical complications.
Subgroup analyses of patients characterized by age (≤65 years, >65 years) and diabetes status showed that menopausal syndrome or HRT remained associated with adverse outcomes in patients aged ≤65 years (aHR, 2.164; 95% CI, 1.333-4.136; p for interaction = 0.3750) and in patients without diabetes (aHR, 2.302; 95% CI, 1.303-4.066; p for interaction = 0.0534) (Table 3 ).