Long-term outcomes of vaginal sling procedures

This study investigated the long-term safety and effectiveness of vaginal sling procedures. Researchers concluded that vaginal sling procedures are a safe and effective long-term treatment option for stress urinary incontinence.

Sling procedures are the most common type of surgery used to help control stress urinary incontinence, and are associated with a high rates of treatment success. Women typically undergo a vaginal sling procedure at between 50 to 65 years of age. Since women are likely to live with the vaginal sling for many years after the procedure, long-term studies are needed to address the safety and effectiveness of vaginal slings over time. 

This study included 256 women that had undergone a vaginal sling procedure for urinary incontinence. Treatment outcome and satisfaction were followed for 10 years.

Overall, treatment with vaginal slings significantly improved continence. Before the procedure, 71% of women used 2 or more incontinence pads every day. Two years after the procedure, 93% of women no longer needed incontinence pads. This was largely maintained at 5 years after surgery (94% of women used no pads) and at 10-year follow-up (83% of women used no pads).

Before treatment, 61% of the women included frequently experienced urinary urgency (a sudden and compelling desire to pass urine). Urinary urgency decreased significantly two years after the vaginal sling procedure, with only 17% of women reporting episodes of urgency. Over time, however, the rate of reported urgency symptoms steadily increased to 32% at 5-year follow-up, and to 42% at 10-year follow-up. Similarly, a frequent need to pass urine at night (called nocturia) initially improved with treatment. After 10 years, however, reported episodes of nocturia were comparable to those from before treatment.

Vaginal sling procedures were generally associated with good treatment satisfaction. Over time, the percentage of women with a high degree of treatment satisfaction declined from 79% at 2 years to 71% at 5 years, and to 63% at 10 years. Analysis showed that older women and women with symptoms related to urinary urgency (including nocturia or smaller bladder capacity) were less likely to be satisfied with the long-term treatment outcome.

No serious complications during the procedure (such as severe bleeding or damage to local tissue) were noted. Most women were discharged the next day after surgery. A total of 9% of women required repeat surgery to mend or replace the vaginal sling during the study follow-up.

The researchers concluded that vaginal sling procedures are associated with very good long-term safety and effectiveness in treating stress urinary incontinence. However, some women may re-experience episodes of urgency 5 to 10 years after treatment, which may reduce treatment satisfaction.