(Poster 67) Treatment Success of Mid-urethral Sling at the Time of Apical Suspension

Objectives: The decision to perform an incontinence procedure at the time of apical prolapse surgery remains controversial as prior studies suggest higher rates of stress urinary incontinence (SUI) treatment failure when midurethral slings (MUS) are performed at the time of prolapse repair. We aimed to assess the difference in SUI treatment outcomes when MUS is done alone or at the time of apical prolapse surgery.

Methods: This was a retrospective cohort study of consecutive patients undergoing isolated MUS or MUS performed at the time of concomitant apical prolapse surgery between June 2023 and 2024 at a single tertiary care center. Surgeries were performed by eight board certified Urogynecology and Reconstructive Pelvic Surgeons. Apical prolapse surgeries included sacrocolpopexy, uterosacral ligament suspension and sacrospinous ligament fixation. Both symptomatic SUI and occult SUI were included. Patients were excluded if they had prior incontinence or prolapse surgery. Patients completed standardized assessments including POP-Q, PFDI, and cough stress test at baseline and 3-months after surgery. SUI treatment failure at 3-months was defined as: (1) patient report of persistent or de novo SUI based on question 3 of UDI-6 “do you experience leaking related to coughing, sneezing or laughing”. (2) positive cough stress test and/or (3) retreatment for SUI (including pessary, pelvic floor physical therapy, or surgery. Assuming a SUI treatment failure of 20% following isolated MUS, we calculated 138 subjects per group were needed to detect a 15% difference in SUI treatment failure at 80% power. Group comparisons performed using Mann-Whitney U and chi-squared tests for continuous and categorical variables respectively.

Results: Three hundred and seventy-seven women were included: 106 (42%) had isolated MUS and 215 (57%) had MUS with apical prolapse surgery. Demographics, clinical, and surgical characteristics are listed in Table 1. Women undergoing isolated MUS were more likely to be younger (p < 0.001), premenopausal (p < 0.001), sexually active (p < 0.001) and have private insurance (p=0.002). They were also less likely to be diabetic (p=0.012) and have a history of prior laparoscopic surgery (p < 0.001). Body mass index (BMI), race, ethnicity, and smoking status did not differ between groups. Overall SUI treatment failure at 3-months was 9.2%: 9.6% in isolate MUS group and 9.0% in apical POP group. Subjective treatment failure with a positive CST was 4.3% and SUI retreatment was 4.9%. Composite SUI treatment failure and individual components of SUI treatment failure were not different between the two groups.

Conclusions: SUI treatment outcomes following MUS were not compromised by concomitant apical prolapse repair.