Sensitivity to Change of Subdomain Question 6 of the Urogenital Distress Inventory Short Form After Sling Removal for Pain

Published:October 30, 2020DOI:


      To determine the sensitivity to change of question 6 (Q6) of the modified short form version of the Urogenital Distress Inventory (UDI-6) before and after synthetic sling removal (SSR).


      Following IRB approval, a prospectively maintained database of mid-urethral sling (MUS) complications identified women with UDI-6 Q6 data before and after SSR. Q6 were compared pre- and postoperatively and against patient self-report of pain in women undergoing -SSR for pain (SSR-P) and in a control group when pain was not the primary indication for SSR (SSR-C). Women with missing pre-SSR or insufficient (<6 months) follow-up measures of pain were excluded. Three hypotheses were tested. (1) Correlation of Q6 scores with patients’ self-reported pain pre- and post-SSR, (2) Higher pre-SSR Q6 scores in the SSR-P group than in the SSR-C group, and (3) Decrease in Q6 scores in the SSR-P group.


      Between 2005 and 2017, 116 of 435 women referred to our institution met study criteria. Q6 scores were significantly (P <.0001) associated with self-reported pain with increasing likelihood of self-reporting pain as Q6 score increased. Mean pre-SSR Q6 scores in SSR-C (n = 42) was 1.0 ± 1.2 while mean pre-SSR Q6 scores in SSR-P (n = 74) was 2.3 ± 1.1 (P <.0001). Mean improvement in Q6 score after SSR was −0.19 ± 1.2 (P = 0.3) in SSR-C and -0.88 ± 1.4 (P <0.0001) in SSR-P.


      In women undergoing SSR for MUS-related complications, Q6 scores were correlated to self-reported pain and responsive to surgical intervention for pain relief.
      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


        • Uebersax JS
        • Wyman JF
        • Shumaker SA
        • McClish DK
        Short forms to assess life quality and symptom distress for urinary incontinence in women: the incontinence impact questionnaire and the urogenital distress inventory.
        Neurourol Urodyn. 1995; 14: 131-139
        • Zimmern PE
        • Kobashi K
        • Lemack GE
        Outcome measure for stress urinary incontinence treatment (OMIT): results of two society of urodynamics and female urology (SUFU) surveys.
        Neurourol Urodyn. 2010; 29: 715-718
        • Lemack GE
        • Zimmern PE
        Identifying patients who require urodynamic testing prior to surgery for stress incontinence based on questionnaire information and surgical history.
        Urology. 2000; 55: 506-511
        • Bako A
        • Dhar R
        Review of synthetic mesh-related complications in pelvic floor reconstructive surgery.
        Int Urogynecol J Pelvic Floor Dysfunct. 2009; 20: 103-111
        • Brubaker L
        • Norton PA
        • Albo ME
        • et al.
        Adverse events over two years after retropubic or trans- obturator midurethral sling surgery: findings from the Trial of Midurethral Slings (TOMUS) study.
        Am J Obstet Gynecol. 2011; 205: 498
        • Hou JC
        • Alhalabi F
        • Lemack LE
        • et al.
        Outcome of transvaginal mesh and tape removed for pain only.
        J Urol. 2014; 192: 856-860
        • Crosby EC
        • Abernethy M
        • Berger MB
        • et al.
        Symptom resolution after operative management of complications from transvaginal mesh.
        Obstet Gynecol. 2014; 123: 134
        • Unger CA
        • Abbott S
        • Evans JM
        • et al.
        Outcomes following treatment for pelvic floor mesh complications.
        Int Urogynecol J. 2014; 25: 745
        • Dillon BE
        • Gurbuz C
        • Zimmern PE
        Long term results after complication of “prophylactic” suburethral tape placement.
        Can J Urol. 2012; 19: 6424
        • Marcus-Braun N
        • von Theobald P
        Mesh removal following transvaginal mesh placement: a case series of 104 operations.
        Int Urogynecol J. 2010; 21: 423
        • Ford AA
        • Rogerson L
        • Cody JD
        • Aluko P
        • Ogah JA
        Mid-urethral sling operations for stress urinary incontinence in women.
        Cochrane Database Syst Rev. 2017; (Issue 7. Art. No.: CD006375)
        • Rogo-Gupta L
        • Grisales T
        • Huynh L
        • et al.
        Symptom improvement after prolapse and incontinence graft removal in a case series of 306 patients.
        Female Pelvic Med Reconstr Surg. 2015; 21: 319-324
        • Danford JM
        • Osborn DJ
        • Reynolds WS
        et al: Postoperative pain outcomes after transvaginal mesh revision.
        Int Urogynecol J. 2015; 26: 65-69
        • Jong K
        • Popat S
        • Christie A
        • et al.
        Is pain relief after vaginal mesh and/or sling removal durable long term?.
        Int Urogynecol J. 2018; 29: 859-864