The use of synthetic midurethral slings (MUS) to treat stress urinary incontinence (SUI) in women has been widespread since the 2000s. Some patients experience medium- to long-term complications, leading to a removal. Few multicentre data are currently published on these removals. The SUSTeR study is a French multicentric cohort study of synthetic MUS removals that investigated the pathway of MUS removal.

This multicentric retrospective study was conducted in 11 centres. Patients who underwent MUS removal after 1 month of placement were included. Data were obtained from medical records. Statistical analysis was performed using R 4,5 software, with a significance threshold set at p < 0.05.

A total of 551 were included for 705 screened. Average age at removal was 60 years old with an average BMI of 26.8. 12.9% had depressive disorders and 8,85% had chronic painful conditions. 12,5 % had chronic painkiller medication. A history of prior MUS was found in 17.5%. MUS were implanted in 25.7% of cases at university hospitals and in 26% of cases at private clinics. 64% had a MUS for pure SUI. MUS had a prior reintervention in another center at 19%. 63.1% removals were made for TOT. 28% of MUS were removed within a year of placement. Average timelapse between implantation and consultation were 67,7 months. Regarding overall ,and moreover complications after 1 year, the holding period of TOTs appeared to be shorter than that of TVTs (83 vs. 109 months, p<0.01). Average time between the first consultation and surgery was 6,8 months, with no increase in people with depression or pain. Regarding to the assessment, a fibroscopy was performed in 76% with 51,5 % removal for exposure. Urodynamic evaluations were made in 35,5 % mainly by cystomanometry. Imaging was realised in 42 %, mainly by specialised sonography for MUS. Average hospitalisation time was 1,5 days with 33,1 % of removal realised in ambulatory. Vaginal total ablation surgeries were significantly longer than a partial one without difference with hospital stay. 1 month complication rate was 8,5 % with only ≥ 1,6 % grade III mainly operative site infection.

Mean time between implantation and consultation for complication symptoms was 67,7 months. Mean time between the first consultation and surgery was 6,8 months.

This study provides an initial epidemiological map of BSU removals in France over the last 15 years. The comparison of MUS lifespan between TVT and TOT should be continued. Since the new French government orders timelapse between consultation and surgery may increase.