Challenges of Multidimensional Outcome Reporting after Suburethral Mid Urethral Sling Removal

Nabeel A. Shakir, Connie Wang, Nirmish Singla, Feras Alhalabi, Alana Christie, Gary E. Lemack, Philippe E. Zimmern

To determine the types and frequency of presenting symptoms in women undergoing sub-urethral mid-urethral sling removal (SSR) towards improving outcome reporting post-SSR. Following IRB approval, women who underwent SSR of one MUS were evaluated for their presenting symptoms and correlation with the Urogenital Distress Inventory-Short form (UDI-6) questionnaire. Demographic data was recorded and patient-reported presenting symptoms were categorized into 5 domains: storage symptoms, voiding symptoms, pain, recurrent UTIs, or urinary incontinence (UI). The UDI-6 was reviewed preoperatively and at 6-12 months postoperatively. An ideal outcome, defined as resolution of incontinence, pain, resumption of sexual activity, and no need for further anti-incontinence procedures was also calculated. From 2006-2017, 230 women met study criteria of whom 116 had UDI-6 questionnaires completed postoperatively. The majority of women (80%) had three or more presenting symptoms, with pain being the most common. The most common combination of symptoms was all five domains (46/230, 20%). Increasing number of symptoms was correlated with total preoperative UDI-6 score, and symptom domains were associated with their corresponding UDI-6 sub-domain questions. Domains not covered by UDI-6 i.e. recurrent UTIs and dyspareunia, accounted for 27% of reported symptoms. Due to limited data on sexual activity, an ideal outcome was reached in 10% of patients, but was at 40% once sexual activity information was excluded. In this series, the presenting symptoms of women undergoing SSR were manifold. The UDI-6 questionnaire correlated with many of these complaints and may be used in outcome analysis in conjunction with self-reported symptoms.