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Pelvic pain and lower urinary tract symptoms; long-term comparison between women with and without mid-urethral sling insertion

Lundmark Drca, Anna ; Alexandridis, Vasileios LU orcid ; Söderberg, Marie Westergren ; Teleman, Pia LU and Ek, Marion (2026) In Acta Obstetricia et Gynecologica Scandinavica
Abstract

Introduction: Stress urinary incontinence is the most prevalent type of incontinence among women, with mid-urethral sling (MUS) surgery considered the gold standard surgical treatment. Despite its widespread use, the role of mesh in this procedure has sparked controversy over the past decade. The primary objective of this study was to compare pelvic pain in women who have undergone MUS surgery with those who have not. The secondary objective was to evaluate lower urinary tract symptoms in both groups. Material and Methods: This prospective cohort study included Swedish women who underwent MUS surgery between 2006 and 2010 and were registered in the GynOp database, and a reference group of Swedish women without MUS, self-registered in... (More)

Introduction: Stress urinary incontinence is the most prevalent type of incontinence among women, with mid-urethral sling (MUS) surgery considered the gold standard surgical treatment. Despite its widespread use, the role of mesh in this procedure has sparked controversy over the past decade. The primary objective of this study was to compare pelvic pain in women who have undergone MUS surgery with those who have not. The secondary objective was to evaluate lower urinary tract symptoms in both groups. Material and Methods: This prospective cohort study included Swedish women who underwent MUS surgery between 2006 and 2010 and were registered in the GynOp database, and a reference group of Swedish women without MUS, self-registered in Lifegene, a national cohort launched in 2009. The women completed the Urogenital Distress Inventory questionnaire-6 (UDI-6) assessing pelvic pain and lower urinary tract symptoms, administered ~10 years after MUS surgery or at matched ages. Results: Pelvic pain was analyzed at least 10 years post-MUS surgery and in the reference group at matched ages. Significant differences in pelvic pain were observed among women aged ≥50 years. Logistic regression analysis, incorporating an interaction between MUS surgery and age, revealed adjusted odds ratios (aOR) for pelvic pain among women with MUS as follows: 0.82 (CI: 0.51–1.31) for women aged <50 years, 1.79 (CI: 1.13–2.42) for women aged 50–59 years, 1.85 (CI: 1.13–3.00) for women aged 60–69 years, and 2.08 (CI: 1.30–3.32) for women ≥70 years. Women with previous MUS surgery reported higher UDI-6 scores, indicating more bothersome lower urinary tract symptoms, except among those aged <50 years, compared with the reference group. Conclusions: Women aged 50 years or older, who have undergone MUS surgery ≥10 years earlier, report more frequent pelvic pain and lower urinary tract symptoms than those who have not undergone MUS surgery. Whether this is related to the MUS surgery or an expression of a progressing pelvic floor dysfunction is unclear.

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author
; ; ; and
organization
publishing date
type
Contribution to journal
publication status
epub
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Acta Obstetricia et Gynecologica Scandinavica
publisher
Wiley-Blackwell
external identifiers
  • pmid:41472493
  • scopus:105026412278
ISSN
0001-6349
DOI
10.1111/aogs.70079
language
English
LU publication?
yes
additional info
Publisher Copyright: © 2025 The Author(s). Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).
id
99431cf0-5651-4298-8159-10fb7ab842b9
date added to LUP
2026-03-23 11:23:34
date last changed
2026-06-15 19:33:49
@article{99431cf0-5651-4298-8159-10fb7ab842b9,
  abstract     = {{<p>Introduction: Stress urinary incontinence is the most prevalent type of incontinence among women, with mid-urethral sling (MUS) surgery considered the gold standard surgical treatment. Despite its widespread use, the role of mesh in this procedure has sparked controversy over the past decade. The primary objective of this study was to compare pelvic pain in women who have undergone MUS surgery with those who have not. The secondary objective was to evaluate lower urinary tract symptoms in both groups. Material and Methods: This prospective cohort study included Swedish women who underwent MUS surgery between 2006 and 2010 and were registered in the GynOp database, and a reference group of Swedish women without MUS, self-registered in Lifegene, a national cohort launched in 2009. The women completed the Urogenital Distress Inventory questionnaire-6 (UDI-6) assessing pelvic pain and lower urinary tract symptoms, administered ~10 years after MUS surgery or at matched ages. Results: Pelvic pain was analyzed at least 10 years post-MUS surgery and in the reference group at matched ages. Significant differences in pelvic pain were observed among women aged ≥50 years. Logistic regression analysis, incorporating an interaction between MUS surgery and age, revealed adjusted odds ratios (aOR) for pelvic pain among women with MUS as follows: 0.82 (CI: 0.51–1.31) for women aged &lt;50 years, 1.79 (CI: 1.13–2.42) for women aged 50–59 years, 1.85 (CI: 1.13–3.00) for women aged 60–69 years, and 2.08 (CI: 1.30–3.32) for women ≥70 years. Women with previous MUS surgery reported higher UDI-6 scores, indicating more bothersome lower urinary tract symptoms, except among those aged &lt;50 years, compared with the reference group. Conclusions: Women aged 50 years or older, who have undergone MUS surgery ≥10 years earlier, report more frequent pelvic pain and lower urinary tract symptoms than those who have not undergone MUS surgery. Whether this is related to the MUS surgery or an expression of a progressing pelvic floor dysfunction is unclear.</p>}},
  author       = {{Lundmark Drca, Anna and Alexandridis, Vasileios and Söderberg, Marie Westergren and Teleman, Pia and Ek, Marion}},
  issn         = {{0001-6349}},
  language     = {{eng}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{Acta Obstetricia et Gynecologica Scandinavica}},
  title        = {{Pelvic pain and lower urinary tract symptoms; long-term comparison between women with and without mid-urethral sling insertion}},
  url          = {{http://dx.doi.org/10.1111/aogs.70079}},
  doi          = {{10.1111/aogs.70079}},
  year         = {{2026}},
}