Midurethral sling (MUS) procedures are the most widely performed surgical treatment for stress urinary incontinence (SUI). While their structural durability is well established, long-term patient-reported outcomes remain less clearly defined. We hypothesized that long-term outcomes of MUS demonstrate divergence between objective continence and patient-reported symptom burden over time.

A structured narrative review of the literature was performed using PubMed to identify studies reporting outcomes of MUS procedures with a minimum follow-up of 10 years. Studies published between January 1996 and March 2026 were screened. Randomized controlled trials, prospective cohorts, and retrospective studies were included.

Eligibility criteria required inclusion of women undergoing MUS for SUI, availability of full-text data, and reporting of long-term clinical outcomes. Studies with follow-up <10 years or insufficient outcome data were excluded.

Data extraction included study design, sample size, follow-up duration, definitions of treatment success, subjective and objective continence outcomes, reoperation rates, mesh-related complications, and de novo overactive bladder (OAB) symptoms. Due to heterogeneity in study design and outcome reporting, results were synthesized descriptively.

Seventeen primary studies met inclusion criteria, with follow-up ranging from 10 to over 25 years. Objective cure rates consistently exceeded 85–90% at 10 years and remained stable through extended follow-up in retropubic cohorts.

In contrast, subjective cure rates demonstrated greater variability and a time-dependent decline in several cohorts, despite stable objective outcomes. Longitudinal data consistently showed divergence between objective continence and patient-reported outcomes.

Randomized long-term comparisons demonstrated broadly comparable continence outcomes between retropubic and transobturator slings, although results varied depending on outcome definitions. Some studies identified superiority of retropubic slings under stricter patient-reported outcome measures.

De novo OAB emerged as the most clinically relevant long-term functional outcome, increasing from approximately 14–18.9% at 10 years to as high as 41.6% at 20 years.

Mesh-related complications were generally low in retropubic cohorts but showed a progressive increase in transobturator cohorts, with erosion rates rising from approximately 2.5% at 10 years to 10% at extended follow-up.

MUS procedures provide durable structural continence over long-term follow-up. However, patient-perceived outcomes are increasingly influenced by evolving storage symptoms, particularly de novo OAB, rather than continence status alone.

The consistent divergence between objective and subjective outcomes suggests that traditional binary definitions of surgical success are insufficient to capture long-term patient experience. Differences between sling types appear more evident in complication profiles and long-term functional outcomes than in overall continence rates.

Long-term outcomes of MUS are characterized by stable objective continence but progressive divergence in patient-reported outcomes. De novo OAB represents the main determinant of long-term dissatisfaction. Future studies should adopt longitudinal, domain-specific outcome measures beyond binary continence definitions to better reflect clinically meaningful outcomes.

Nilsson CG, Palva K, Aarnio R, Morcos E, Falconer C. Seventeen years' follow-up of the TVT procedure. Int Urogynecol J. 2013;24(8):1265–1269.
Offiah I, Freeman R. Long-term efficacy and complications of a multicentre randomized controlled trial comparing retropubic and transobturator mid-urethral slings. BJOG. 2021;128(13):2191–2199.
Braga A, Caccia G, Papadia A, et al. The subjective and objective very long-term outcomes of TVT: a 20-year follow-up. Int Urogynecol J. 2022;33(4):947–953.