Synthetic mid-urethral sling (MUS) removal carries a risk of recurrence of stress urinary incontinence (SUI) or urge urinary incontinence (UUI). Some patients maintain continence after removal, suggesting protective factors. Similarly, the progression of overactive bladder (OAB) can range from relapse to recovery. The SUSTER study is a French multicentre study of MUS removals for medium- and long-term complications, which investigated the progression and management of urinary incontinence after removal.

11 specialised centers collected data. Data collection was from medical records. SUI was graded according to the number of protections used per day or according to the grade issued by the clinician during the consultation. OAB and UUI were analysed together. Statistical analysis with R (4.5) p < 0.05.

551 patients were included for 705 screened. The average age was 60 years old. SUI was the leading symptom for reoperation in 8% of cases, OAB/UUI in 10.4%. A total of 18% of removals were total according to the last ICS terminology on MUS removal, 70 % had a vaginal approach alone. Pre-removal SUI rate were 33%. SUI were persistent in 76 % of them, and recurrent in 53% among others. 61 % had post-removal SUI. Total or partial subtotal removal induced more post removal SUI than suburethral removal, after a total removal SUI was more severe than in partial. 13.5 % with pre-removal SUI had a concurrent SUI surgery to the removal. 40.5 % had surgery for persistent/recurrent SUI. Types, rate and efficacy of surgical treatment are shown in figure 1. Treatments were effective in 68.8 %. At 1-year visit without SUI intervention showed SUI in 56% of cases, severe in 30%. Pelvic reeducation didn't seem to significantly decrease SUI rate. Second MUS implantation were effective even in exposure context. Artificial urinary sphincters were the most effective treatment.

The risk of urinary incontinence recurrence after tape removal is 53 %. However, it can be successfully treated in almost 70 % of the cases.

This study highlights the rate of persistent and recurrent SUI after MUS removal. Some patients undergo a surgery for post removal SUI, effectiveness of treatment must be part of the discussion for its treatment. Reimplantation of synthetic MUS seems possible but requires vigilance.