title: Slings may not fail as frequently as believed for stress urinary incontinence: the misinterpretation of postoperative voiding dysfunction as failure based on patient report.
abstract: OBJECTIVE
  : Sling operations may obstruct the urethra, promoting voiding dysfunction and secondary urine leakage that are incorrectly attributed to surgical failure.
  
  
  METHODS
  : We prospectively evaluated the evolution of urinary symptoms in the postoperative follow-up of 108 polypropylene sling cases. Patients presented for follow-up at 1, 3, 6, 12, 18, 24, 36, and 48 months for review of individual urinary symptoms. Statistical analysis used Fisher exact test.
  
  
  RESULTS
  : On the 30th postoperative day, 100% of the cases were cured of stress urinary incontinence, although frequency (62.9%), urgency (29.6%), urge-incontinence (23.1%), nocturia (28.6%), incomplete voiding sensation (11.1%), and poor stream (11.1%) persisted. At 3 months, 16.6% reported frequency, 38% complained of urgency, and 29.6% were troubled by nocturia. True urinary leakage under stress was resolved in 100% of cases by the first visit and did not show any further decrease when specifically questioned. Pad usage decreased after 3 months but did not completely disappear after 48 months. A total of 94.4% of the cases achieved total continence and clinical satisfaction after 4 years of follow-up, in parallel with the steady disappearance of voiding dysfunction observed in the early postoperative period.
  
  
  CONCLUSIONS
  : Voiding dysfunction after sling procedures is frequent but transitory. As symptoms improve or disappear, patients tend to miss their follow-up. In this study, 94.4% of the cases had complete dryness and satisfaction with the operation.
authors.affiliation: From the Section of Neurourology and Voiding Disturbances, Hospital Beneficência Portuguesa of São Paulo and Hospital 9 de Julho of São Paulo, São Paulo, Brazil.
authors.forename: Paulo
authors.initials: P
authors.lastname: Rodrigues
authors.forename: Flávio
authors.initials: F
authors.lastname: Hering
authors.forename: Alex
authors.initials: A
authors.lastname: Meller
authors.forename: João Carlos
authors.initials: JC
authors.lastname: Campagnari