Complications associated with suburethral sling implantation: a comprehensive analysis

Introduction. Stress urinary incontinence is widely prevalent among women, and the use of mid-urethral slings (MUS) is associated with a risk of complications, which necessitates clarification of their causes and consequences for quality of life.

Objective. To perform a comprehensive analysis of complications associated with synthetic MUS implantation, identifying the structure of complications, contributing factors, and their impact on quality of life.

Materials & methods. A retrospective study was conducted on 148 female patients who underwent surgical sling removal due to complications between 2022 and 2024. Clinical characteristics, concomitant procedures, urodynamic data, and results from standardized questionnaires (UDI-6, ICIQ-SF, PISQ-12) and the Visual Analog Scale for pain (VAS) were analyzed.

Results. The most common complications were chronic pain syndrome (29.1%), obstructive voiding (26.4%), and mesh extrusion (16.2%). A combination of two or more complications was identified in 68% of patients, most commonly pain combined with obstruction (21.6%). Incorrect sling positioning was detected in 17.5% of women. Among patients operated on by surgeons with less than 5 years of experience, the frequency of obstruction and pain was 2.3 times higher (p = 0.03). Concomitant sling implantation during pelvic organ prolapse repair was found to be associated with a higher risk of complications (p = 0.037). Conservative treatment administered before explantation proved ineffective in most cases. The time to detection of complications ranged from 3 months to 1.5 years, with some erosions being asymptomatic and diagnosed incidentally.

Conclusions. The study results demonstrate the multifactorial nature of complications after MUS implantation. Significant risk factors were identified, including suboptimal implant positioning, limited surgeon experience, and concomitant procedures. The findings emphasize the need for careful preoperative planning, adherence to surgical technique, and long-term postoperative follow-up.

1. Walker GJ, Gunasekera P. Pelvic organ prolapse and incontinence in developing countries: review of prevalence and risk factors. Int Urogynecol J. 2011;22(2):127-135. DOI: 10.1007/s00192-010-1215-0

2. Tennstedt SL, Link CL, Steers WD, McKinlay JB. Prevalence of and risk factors for urine leakage in a racially and ethnically diverse population: the Boston Area Community Health (BACH) Survey. Am. J. Epidemiol. 2008;167(4):390-399. DOI: 10.1093/aje/kwn126

3. Afanasyevskaya E.V., Kadysheva A.M., Lazareva E.K., Gvozdev M.Yu. Overactive bladder de novo after sling surgery for urinary incontinence in women. Urology Herald. 2025;13(5):71-79. (In Russian). DOI: 10.21886/2308-6424-2025-13-5-71-79

4. Minassian VA, Drutz HP, Al-Badr A. Urinary incontinence as a worldwide problem. Int J Gynaecol Obstet. 2003;82(3):327-338. DOI: 10.1016/s0020-7292(03)00220-0

5. Shkodkin S.V., Ponomarev E.G., Nechiporenko V.Y., Shkodkin K.S., Rakhmоnov T.B., Chopanov S.A., Mukhamedov H.A., Askari J.K. Approaches to the treatment of incontinence in women. Bashkortostan Medical Journal. 2023;18(1):39-44. (In Russian). eLIBRARY ID: 50364036; EDN: JXCWSJ

6. Hunskaar S. A systematic review of overweight and obesity as risk factors and targets for clinical intervention for urinary incontinence in women. Neurourol Urodyn. 2008;27(8):749-757. DOI: 10.1002/nau.20635

7. Farag F, Osman NI, Pang KH, Castro-Diaz D, Chapple CR, Cruz F, Gamé X, Goldman H, Greenwell T, Hampel C, Scailteux LM, Roovers JP, Welk B, Heesakkers J. Complications of Synthetic Midurethral Slings: Is There a Relevant Discrepancy Between Observational Data and Clinical Trials? Eur Urol Focus. 2024;10(4):535-550. DOI: 10.1016/j.euf.2023.11.002

8. Gurol-Urganci I, Geary RS, Mamza JB, Duckett J, El-Hamamsy D, Dolan L, Tincello DG, van der Meulen J. Long-term Rate of Mesh Sling Removal Following Midurethral Mesh Sling Insertion Among Women With Stress Urinary Incontinence. JAMA. 2018;320(16):1659-1669. DOI: 10.1001/jama.2018.14997

9. Shakhaliev R.A., Shulgin A.S., Kubin N.D., Kuzmina I.N., Suchkov D.A., Shkarupa D.D. Current status of transvaginal mesh implants use in the surgical treatment of stress urinary incontinence and pelvic prolapse. Gynecology. 2022;24(3):174-180. (In Russian). DOI: 10.26442/20795696.2022.3.201423

10. MacCraith E, Cunnane EM, Joyce M, Forde JC, O’Brien FJ, Davis NF. Comparison of synthetic mesh erosion and chronic pain rates after surgery for pelvic organ prolapse and stress urinary incontinence: a systematic review. Int Urogynecol J. 2021;32(3):573-580. DOI: 10.1007/s00192-020-04612-x

11. Morling JR, McAllister DA, Agur W, Fischbacher CM, Glazener CM, Guerrero K, Hopkins L, Wood R. Adverse events after first, single, mesh and non-mesh surgical procedures for stress urinary incontinence and pelvic organ prolapse in Scotland, 1997-2016: a population-based cohort study. Lancet. 2017;389(10069):629-640. DOI: 10.1016/S0140-6736(16)32572-7

12. Karmakar D, Mostafa A, Abdel-Fattah M. Long-term outcomes of transobturator tapes in women with stress urinary incontinence: E-TOT randomised controlled trial. BJOG. 2017;124(6):973-981. DOI: 10.1111/1471-0528.14561

13. Ford AA, Rogerson L, Cody JD, Ogah J. Mid-urethral sling operations for stress urinary incontinence in women. Cochrane Database Syst Rev. 2015;(7):CD006375. Update in: Cochrane Database Syst Rev. 2017;7:CD006375. DOI: 10.1002/14651858.CD006375.pub3

14. Kasyan G.R., Aliev O.R., Pushkar D.Yu. Tension-controlled suburethral synthetic sling versus standard sling in the treatment of female stress urinary incontinence: preliminary short-term results. Urology Herald. 2025;13(2):22-30. (In Russian). DOI: 10.21886/2308-6424-2025-13-2-22-30

15. van der Ploeg JM, van der Steen A, Zwolsman S, van der Vaart CH, Roovers J. Prolapse surgery with or without incontinence procedure: a systematic review and meta-analysis. BJOG. 2018;125(3):289-297. DOI: 10.1111/1471-0528.14943

16. Abed H, Rahn DD, Lowenstein L, Balk EM, Clemons JL, Rogers RG; Systematic Review Group of the Society of Gynecologic Surgeons. Incidence and management of graft erosion, wound granulation, and dyspareunia following vaginal prolapse repair with graft materials: a systematic review. Int Urogynecol J. 2011;22(7):789-798. DOI: 10.1007/s00192-011-1384-5

17. Baessler K, Christmann-Schmid C, Maher C, Haya N, Crawford TJ, Brown J. Surgery for women with pelvic organ prolapse with or without stress urinary incontinence. Cochrane Database Syst Rev. 2018;8(8):CD013108. Update in: Cochrane Database Syst Rev. 2026;2:CD013108. DOI: 10.1002/14651858.CD013108

18. Gomes CM, Carvalho FL, Bellucci CHS, Hemerly TS, Baracat F, de Bessa J Jr, Srougi M, Bruschini H. Update on complications of synthetic suburethral slings. Int Braz J Urol. 2017;43(5):822-834. DOI: 10.1590/S1677-5538.IBJU.2016.0250

19. Zwierzchowska A, Tomasik P, Horosz E, Barcz E. Sonography as a Diagnostic Tool in Midurethral Sling Complications: A Narrative Review. J Clin Med. 2024;13(8):2336. DOI: 10.3390/jcm13082336