Limited data exists on long-term outcomes from mid-urethral sling (MUS) in the treatment of stress urinary incontinence (SUI).  
The primary aim of this study was to compare short-, mid- and long-term subjective treatment success in women undergoing 
MUS.

Women undergoing a MUS procedure between 2001 and 2009 were identified by CPT code for this retrospective cohort 
study.  Baseline demographics were abstracted from the medical record.  Eligible patients were mailed the Urinary Distress 
Inventory Short Form (UDI-6), Pelvic Floor Impact Questionnaire (PFIQ-7), Patient Global Impression of Improvement (PGI-I), 
and Patient Satisfaction Questionnaire (PSQ).  Patients in the long-term cohort were also asked whether they would undergo 
a MUS procedure again.  Patients were categorized by interval follow up from surgery as short-term (interval ≤ 36 months), 
mid-term (>36 months to ≤ 70 months), and long-term (interval ≥ 119 months).  The primary outcome was “treatment 
success” defined as response of “not at all” or “somewhat” to both SUI questions on the UDI-6 which are “Do you usually 
experience small amounts of urine leakage (that is, drops)?” and “Do you usually experience urine leakage related to 
coughing, sneezing, or laughing?” Chi-squared tests for categorical variables, and analysis of variance (ANOVA) or 
Kruskal-Wallis for continuous variables were utilized. Logistic regression was used to examine the association between 
follow-up group and subjective treatment success between short- and combined mid- and long-term follow-up groups 
after adjustment for covariates.

Overall response rate was 40.3% (N= 896/2221) with a total of N=361 in the short-, N=251 in the mid-, and N=284 
in the long-term group returning questionnaires.  Mean follow up was 23.3 ± 7.2 months for short-, 49.8 ± 9.1 
months for mid-, and 147.9 ± 20.6 months for long-term.  Differences were significant for age (short: 60.9±11.6, mid:
60.3 ± 12.5, long: 58.4±10.5, p=0.03), smoking status, prior prolapse surgery, and perioperative vaginal estrogen use 
(all p<0.05).  No differences in race, body mass index, medical comorbidities (COPD), parity with mode of delivery, and 
menopausal status were seen among groups.  Treatment success differed among groups: 75.4% in the short-, 62.3% 
mid-, and 67.0% long-term groups, p<0.01. There was no difference in treatment success between mid- and long-term 
follow-up groups (p=0.28). Logistic regression showed that women with mid- or long-term follow-up were nearly half as 
likely as their short-term counterparts to report subjective treatment success, adjusted odds ratio 0.51 (95% Confidence 
Interval: 0.36, 0.74) controlling for potential confounding factors (age, race, BMI categories, comorbidities, smoking, 
mode of delivery, prior or concurrent pelvic surgeries, and type of sling). Median UDI-6 and PFIQ-7 scores as well as 
PGI-I differed significantly across short-, mid- and long-term follow-up groups (all p<0.01,Table). Patient satisfaction 
was similar: “completely” and “somewhat satisfied” in 83.3% short-, 76.6% mid-, 78.2% long-term follow-up (p = 0.09). 
In the long-term group, 73.1% reported they would undergo a MUS again.

Subjective treatment success, post-operative symptom severity, and condition-specific QOL differed among short-, mid-, and
long-term groups, with higher success and improved symptoms in the short-term group of women undergoing MUS.  There 
is a drop from short- to mid- and long-term success which is stable and sustained to 12 years.  Patients with mid- and 
long-term follow-up were less likely to report subjective treatment success controlling for potential confounders.  
High satisfaction was sustained across the all follow-up groups.

Mid-urethral sling is considered the gold-standard for treatment of SUI but there is still a paucity of data on 
long-term outcomes.  There was high satisfaction which was sustained for patients with long-term follow-up 
(mean length of over 12 years) but subjective success in combined mid- and long-term follow-up was nearly 
half as likely as their shorter-term counterparts.  This information is of value to the literature and informs to 
patient expectations.