Challenges of Very Long-term Reporting in Stress Urinary Incontinence Surgeries in Women

Published:February 04, 2020DOI:



      To review studies on surgeries to correct stress urinary incontinence (SUI) with very long-term results (≥ 10 years) to explore the challenges in reporting long-term follow-up.


      A comprehensive Ovid and PubMed search was conducted for articles containing long-term data over 10 years for the most commonly established surgical procedures to correct SUI. The methods of follow-up, lost to follow-up (LTF) rates, cure rates, and complications were compared.


      SUI corrective surgeries reviewed included: tension free vaginal tape, transobturator sling, retropubic suspensions (Burch, Marshall-Marchetti-Krantz), autologous fascial sling, and Stamey needle suspension. Mean follow-up of all 17 studies was 12.6 years (range: 10-17 years) with sample sizes ranging from 26 to 650 patients. Methods of follow-up included clinic visits (n = 11), telephone interviews (n = 8), or mailed questionnaires (n = 5). Mean LTF rate was 24% (range: 10-49%). Mean objective and subjective cure rate with varying success definitions was 86% (range 81-91%) and 69%, respectively (range: 33-94%). The most common complications included de novo urgency (range: 2-70%), repeat SUI/prolapse surgeries (range: 2–37%), mesh/suture exposure (range: 1–9%), voiding problems (range: 2–36%), and pain (range: 2–14%).


      All very long-term data for SUI surgeries share considerable LTF, infrequent examination data, mostly questionnaire-based information, and variable success rates from varying success definitions. Standardization of all these key outcome measures is urgently needed to provide more reliable long-term information on the outcome of these procedures.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Urology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Haylen BT
        • de Ridder D
        • Freeman RM
        • et al.
        An International Urogynecological Association (IUGA)/International Continence Society (ICS) Joint Report on the Terminology for Female Pelvic Floor Dysfunction.
        Neurourol Urodyn. 2010; 29: 4-20
        • Chong EC
        • Khan AA
        • Anger JT
        The financial burden of stress urinary incontinence among women in the United States.
        Curr Urol Rep. 2011; 12: 358-362
        • Haylen BT
        • Lee JK
        • Sivagnanam V
        • Cross A
        What if there were no tapes?.
        Neurourol Urodyn. 2018; 37: 2026-2034
        • Brubaker L
        • Richter HE
        • Norton PA
        • et al.
        5-year continence rates, satisfaction and adverse events of Burch urethropexy and fascial sling surgery for urinary incontinence.
        J Urol. 2012; 187: 1324-1330
        • Kuprasertkul A
        • Christie AL
        • Lemack GE
        • Zimmern P
        Follow-up of E-SISTEr participants at one site to evaluate the very long-term results of Burch vs Authologous Sling procedure for stress urinary incontinence.
        J Urol. 2019; 202: 1224-1229
        • Kenton K
        • Stoddard AM
        • Zyczynski H
        • et al.
        5-year longitudinal followup after retropubic and transobturator mid urethral slings.
        J Urol. 2015; 193: 203-210
        • Ou R
        • Xie XJ
        • Zimmern PE
        Level I/II evidence-based studies of surgical treatment of female stress urinary incontinence: patients lost to followup.
        J Urol. 2011; 185: 1338-1343
        • Moher D
        • Liberati A
        • Tetzlaff J
        • Altman DG
        • The PRISMA Group
        Preferred reporting items for systematic reviews and MetaAnalyses: the PRISMA statement.
        PLoS Med. 2009; 6e1000097
        • Nilsson CG
        • Palva K
        • Aarnio R
        • Morcos E
        • Falconer C
        Seventeen years' follow-up of the tension-free vaginal tape procedure for female stress urinary incontinence.
        Int Urogynecol J. 2013; 24: 1265-1269
        • Braga A
        • Caccia G
        • Sorice P
        • et al.
        Tension-free vaginal tape for treatment of pure urodynamic stress urinary incontinence: efficacy and adverse effects at 17-year follow-up.
        BJU Int. 2018; 122: 113-117
        • Al-Zahrani AA
        • Gajewski J
        Long-term patient satisfaction after retropubic and transobturator mid-urethral slings for female stress urinary incontinence.
        J Obstet Gynaecol Res. 2016; 42: 1180-1185
        • Kjolhede P
        Long-term efficacy of Burch colposuspension: a 14-year follow-up study.
        Acta Obst Gynecol Scand. 2005; 84: 767-772
        • Clemens JQ
        • Stern JA
        • Bushman WA
        • Schaeffer AJ
        Long-term results of the Stamey bladder neck suspension: direct comparison with the Marshall-Marchetti-Krantz procedure.
        J Urol. 1998; 160: 372-376
        • Khan ZA
        • Nambiar A
        • Morley R
        • Chapple CR
        • Emery SJ
        • Lucas MG
        Long-term follow-up of a multicentre randomised controlled trial comparing tension-free vaginal tape, xenograft and autologous fascial slings for the treatment of stress urinary incontinence in women.
        BJU Int. 2015; 115: 968-977
        • Song PH
        • Kwon DH
        • Ko YH
        • Jung HC
        The long-term outcomes of the tension-free vaginal tape procedure for treatment of female stress urinary incontinence: data from minimum 13 years of follow-up.
        Luts. 2017; 9: 10-14
        • Serati M
        • Sorice P
        • Bogani G
        • et al.
        TVT for the treatment of urodynamic stress incontinence: efficacy and adverse effects at 13-year follow-up.
        Neurourol Urodyn. 2017; 36: 192-197
        • Han JY
        • Park J
        • Choo MS
        Long-term durability, functional outcomes, and factors associated with surgical failure of tension-free vaginal tape procedure.
        Int Urol Nephrol. 2014; 46: 1921-1927
        • Olsson I
        • Abrahamsson AK
        • Kroon UB
        Long-term efficacy of the tension-free vaginal tape procedure for the treatment of urinary incontinence: a retrospective follow-up 11.5 years post-operatively.
        Int Urogynecol J. 2010; 21: 679-683
        • Heinonen P
        • Ala-Nissila S
        • Kiilholma P
        • Laurikainen E
        Tension-free vaginal tape procedure without preoperative urodynamic examination: long-term outcome.
        Int J Urol. 2012; 19: 1003-1009
        • Sharifiaghdas F
        • Mirzaei M
        • Daneshpajooh A
        • Narouie B
        Long-term results of tension-free vaginal tape and pubovaginal sling in the treatment of stress urinary incontinence in female patients.
        Clin Exp Obstet Gynecol. 2017; 44: 44-47
        • Svenningsen R
        • Staff AC
        • Schiotz HA
        • Western K
        • Sandvik L
        • Kulseng-Hanssen S
        Risk factors for long-term failure of the retropubic tension-free vaginal tape procedure.
        Neurourol Urodyn. 2013; 33: 1140-1146
        • Zhang Y
        • Song X
        • Zhang Z
        • et al.
        Tension-free vaginal tape-obturator for the treatment of stress urinary incontinence: a 12-year prospective follow-up.
        BJU Int. 2019; 123: E57-E62
        • Natale F
        • Illiano E
        • Marchesi A
        • et al.
        Transobturator tape: over 10 years follow-up.
        Urology. 2019; 129: 48-53
        • Luna MTC
        • Hirakawa T
        • Kamura T
        • et al.
        Comparison of the anterior colporrhaphy procedure and the Marshall-Marchetti-Krantz operation in the treatment of stress urinary incontinence among women.
        J Obstet Gynaecol. 1999; 25: 255-260
        • Langer R
        • Lipshitz Y
        • Halperin R
        • Pansky M
        • Bukovsky I
        • Sherman D
        Long-term (10–15 years) follow-up after Burch colposuspension for urinary stress incontinence.
        Int Urogynecol J. 2001; 12 (discussion 326-327): 323-326
        • Zimmern PE
        • Dandreo KJ
        • Sirls L
        • et al.
        Lessons from a patient experience survey in a randomized surgical trial of treatment of stress urinary incontinence in women.
        Int Urogynecol J. 2011; 22: 1273-1278
        • Frick AC
        • Ridgeway B
        • Ellerkmann M
        • et al.
        Comparison of responsiveness of validated outcome measures after surgery for stress urinary incontinence.
        J Urol. 2010; 184: 2013-2017
        • Brubaker L
        • Litman JH
        • Hae-Young K
        • et al.
        Missing data frequency and correlates in two randomized surgical trials for urinary incontinence in women.
        Int Urogynecol J. 2015; 26: 1155-1159
        • Elliott CS
        • Sokol ER
        Might pelvic surgeons be unaware of their surgical failures? Patient reporting and perceptions after failed incontinence or pelvic organ prolapse surgery.
        Female Pelvic Med Reconstr Surg. 2015; 21: 298-300
        • Foster J
        • Christie A
        • Zimmern PE
        Factors influencing the rate of lost to followup after suburethral synthetic sling removal.
        Urol Pract. 2018; 5: 101-106