title: Indications and risk factors for midurethral sling revision.
abstract: OBJECTIVE
  To determine the indications and risk factors for needing midurethral sling revision in a cohort of women undergoing midurethral sling placement.
  
  
  METHODS
  This was a case-control study of all women undergoing midurethral sling placement for stress urinary incontinence (SUI) between January 2003 and December 2013. Cases were patients who underwent midurethral sling placement followed by sling revision (incision, partial or complete excision). Controls were patients who underwent sling placement only. Once all subjects had been identified, the electronic medical record was queried for demographic and perioperative and postoperative data.
  
  
  RESULTS
  Of 3,307 women who underwent sling placement, 89 (2.7%, 95% CI 1.9 - 3.4) underwent sling revision for one or more of the following indications: urinary retention (43.8%), voiding dysfunction (42.7%), recurrent urinary tract infection (20.2%), mesh erosion (21.3%), vaginal pain/dyspareunia (7.9%), and groin pain (3.4%). The median time from the index to the revision surgery was 7.8 months (2.3 - 17.9 months), but was significantly shorter in patients with urinary retention. The type of sling placed (retropubic or transobturator) was not associated with indication for revision. Patients who underwent revision surgery were more likely to have had previous SUI surgery (adjusted odds ratio 4.4, 95% CI 1.7 - 6.5) and to have undergone concomitant vaginal apical suspension (adjusted odds ratio 2.4, 95% CI 1.4 - 4.5).
  
  
  CONCLUSIONS
  The rate of sling revision after midurethral sling placement was 2.7%. Urinary retention and voiding dysfunction were the most common indications. Patients with a history of previous SUI surgery and concomitant apical suspension at the time of sling placement may be at higher risk of requiring revision surgery.
authors.affiliation: Obstetrics, Gynecology and Women's Health Institute, Center for Urogynecology and Pelvic Reconstructive Surgery, Cleveland Clinic, 9500 Euclid Avenue/A81, Cleveland, OH, 44195, USA. ungerc@ccf.org.
authors.forename: Cecile A
authors.initials: CA
authors.lastname: Unger
authors.affiliation: Obstetrics, Gynecology and Women's Health Institute, Center for Urogynecology and Pelvic Reconstructive Surgery, Cleveland Clinic, 9500 Euclid Avenue/A81, Cleveland, OH, 44195, USA.
authors.forename: Anthony E
authors.initials: AE
authors.lastname: Rizzo
authors.affiliation: Obstetrics, Gynecology and Women's Health Institute, Center for Urogynecology and Pelvic Reconstructive Surgery, Cleveland Clinic, 9500 Euclid Avenue/A81, Cleveland, OH, 44195, USA.
authors.forename: Beri
authors.initials: B
authors.lastname: Ridgeway
mesh_terms: D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D053825:Suburethral Slings; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000601:surgery*
keywords: Midurethral sling; Revision of sling; Urethrolysis; Vaginal mesh; Voiding dysfunction