Challenges of Very Long-term Reporting in Stress Urinary Incontinence Surgeries in Women.

Objective: To review studies on surgeries to correct stress urinary incontinence (SUI) with very long-term results (≥ 10 years) to explore the challenges in reporting long-term follow-up.

Methods: A comprehensive Ovid and PubMed search was conducted for articles containing long-term data over 10 years for the most commonly established surgical procedures to correct SUI. The methods of follow-up, lost to follow-up (LTF) rates, cure rates, and complications were compared.

Results: SUI corrective surgeries reviewed included: tension free vaginal tape, transobturator sling, retropubic suspensions (Burch, Marshall-Marchetti-Krantz), autologous fascial sling, and Stamey needle suspension. Mean follow-up of all 17 studies was 12.6 years (range: 10-17 years) with sample sizes ranging from 26 to 650 patients. Methods of follow-up included clinic visits (n = 11), telephone interviews (n = 8), or mailed questionnaires (n = 5). Mean LTF rate was 24% (range: 10-49%). Mean objective and subjective cure rate with varying success definitions was 86% (range 81-91%) and 69%, respectively (range: 33-94%). The most common complications included de novo urgency (range: 2-70%), repeat SUI/prolapse surgeries (range: 2-37%), mesh/suture exposure (range: 1-9%), voiding problems (range: 2-36%), and pain (range: 2-14%).

Conclusion: All very long-term data for SUI surgeries share considerable LTF, infrequent examination data, mostly questionnaire-based information, and variable success rates from varying success definitions. Standardization of all these key outcome measures is urgently needed to provide more reliable long-term information on the outcome of these procedures.