Urinary incontinence (UI) is a prevalent geriatric syndrome that disproportionately affects women. With aging, there is poor urethral coaptation and weakened intrinsic and extrinsic urethral musculature that makes clinical management decisions difficult.  Evidence regarding the impact of aging beyond 65 years on midurethral sling (MUS) outcomes remains inconsistent. We hypothesize that due to age-related changes in urethral function, older age is a significant predictor of midurehtral sling treatment failure.  We aim to systematically review the literature to definitively characterize the relationship between age and midurethal sling efficacy to help establish treatment guidelines optimizing treatment selection for stress urinary incontinence (SUI) outcomes in older adults.

A scoping review was conducted to evaluate the influence of age on treatment outcomes following midurethral sling (MUS) procedures in older women with stress urinary incontinence (SUI). A comprehensive search strategy targeting studies of procedure based interventions for urinary incontinence was developed, and electronic databases—including PubMed, MEDLINE (Ovid), Embase, and Web of Science—were systematically queried. Search terms encompassed older women, stress urinary incontinence, surgery, procedures, and sling. The search was limited to studies published from 2014 onward. Covidence® software was used to manage study screening and data organization. Eligible studies included those reporting objective or subjective efficacy outcomes of MUS procedures in women aged ≥65 years. Studies were excluded if they focused on conservative management, included populations with neurogenic lower urinary tract dysfunction or overactive bladder, involved concomitant pelvic organ prolapse surgery, lacked an age stratified analysis, or were scoping/systematic reviews.

53 studies providing data on MUS efficacy/failure rates with an age-based analysis of outcomes were included. Of these 53 studies, 19/53 (35.8%) provided evidence that increased age negatively affects treatment outcomes. Subjective improvement of stress UI symptoms was determined with validated questionnaires, most commonly the UDI-6 and IIQ-7. (Figure 1) Age >65 years has a negative impact on subjective improvement of stress UI following midurethral sling. However, urgency UI symptoms have higher odds of persistence after midurehtral sling. Objective outcome assessments were variable. However, lower odds of objective reduction in stress UI symptoms after midurethral sling is associated with age >65 years. (Figure 2) Increased age is also associated with increased likelihood of failing a postoperative cough stress test.

Age older than 65 years is associated with lower subjective recurrence of stress or urgency UI symptoms and higher objective failure rates after midurehtral sling.

The phenotype of stress/mixed UI symptoms in women older than 65 years is different compared to younger women. Although midurethral sling (MUS) procedures consistently demonstrate subjective symptom improvement across age groups, few studies have specifically evaluated age >65 years as an independent predictor of subjective or objective MUS outcomes. Heterogeneity in outcome measures and reporting has further limited comparative analysis, leaving the efficacy of MUS for treating stress UI in older women uncertain. Rigorous, age stratified studies are needed to clarify treatment effectiveness and guide procedure based management of stress or mixed UI in this population.