經過多年的手術演變，尿道網膜中段吊帶手術已是應力型尿失禁手術的主流方式。但每個手術都有其併發症可能，對於網膜(Mesh)手術來說，網膜裸露、性交疼痛或是尿失禁復發是少數病人的惡夢。過去這些併發症雖然為人所知，但是長期因為這些副作用而將網膜移除或是重新進行手術的比率並不清楚，而這篇大型研究追蹤了約10萬個18歲以上的病人接受過恥骨上緣尿道往吊帶手術或經閉鎖孔尿道網膜吊帶手術。其中60194名病人接受了恥骨上緣吊帶手術，34863名病人接受了經閉鎖孔尿道吊帶手術。追蹤時間的中位數為5.5年。

對於網膜吊帶移除率，第一年為1.4%，第五年為2.7%，第九年為3.3%。而相較於恥骨上緣吊帶手術，經閉鎖孔尿道吊帶手術有較低的吊帶移除率(3.6% v.s. 2.7%)，而本篇探討出最有可能原因是移除經閉鎖孔網膜吊帶的難度比較高所以移除率較低。而隨著病人做手術時的年紀越老，吊帶移除的風險也比較低。

而吊帶手術後再進行第二次吊帶手術的發生率，第一年是1.3%，第五年是3.5%，第九年是6.9%。在第九年追蹤時，相較於恥骨上緣吊帶手術，經閉鎖孔尿道吊帶手術有較高的再次尿失禁手術率(4.1% v.s. 5.3%)。本篇還發現，過去如果有接受過尿道填充物手術或是非吊帶式尿失禁手術，再度接受尿失禁手術的比率也比較高，其中有接受過尿道填充物者手術者風險高了1.74倍，有接受過非吊帶式尿失禁手術風險高了2.6倍。

而本篇的追蹤的病人的時間相當久，第九年時預估吊帶的移除率為3.3%。雖然尿道吊帶手術的效果非常好，但畢竟吊帶為外來物，進行手術的醫師在手術前也必須告知可能吊帶裸露、疼痛的副作用或是失效，以及可能未來需要移除或重新手術的風險，手術前要報喜也要報憂。

Importance
There is concern about outcomes of midurethral mesh sling insertion for women with stress urinary incontinence. However, there is little evidence on long-term outcomes.

Objective
To examine long-term mesh removal and reoperation rates in women who had a midurethral mesh sling insertion for stress urinary incontinence.

Design, setting, and participants
This population-based retrospective cohort study included 95 057 women aged 18 years or older who had a first-ever midurethral mesh sling insertion for stress urinary incontinence in the National Health Service hospitals in England between April 1, 2006, and December 31, 2015. Women were followed up until April 1, 2016.

Exposures
Patient and hospital factors and retropubic or transobturator mesh sling insertions.

Main outcomes and measures
The primary outcome was the risk of midurethral mesh sling removal (partial or total) and secondary outcomes were reoperation for stress urinary incontinence and any reoperation including mesh removal, calculated with death as competing risk. A multivariable Fine-Gray model was used to calculate subdistribution hazard ratios as estimates of relative risk.

Results
The study population consisted of 95 057 women (median age, 51 years; interquartile range, 44-61 years) with first midurethral mesh sling insertion, including 60 194 with retropubic insertion and 34 863 with transobturator insertion. The median follow-up time was 5.5 years (interquartile range, 3.2-7.5 years). The rate of midurethral mesh sling removal was 1.4% (95% CI, 1.3%-1.4%) at 1 year, 2.7% (95% CI, 2.6%-2.8%) at 5 years, and 3.3% (95% CI, 3.2%-3.4%) at 9 years. Risk of removal declined with age. The 9-year removal risk after transobturator insertion (2.7% [95% CI, 2.4%-2.9%]) was lower than the risk after retropubic insertion (3.6% [95% CI, 3.5%-3.8%]; subdistribution hazard ratio, 0.72 [95% CI, 0.62-0.84]). The rate of reoperation for stress urinary incontinence was 1.3% (95% CI, 1.3%-1.4%) at 1 year, 3.5% (95% CI, 3.4%-3.6%) at 5 years, and 4.5% (95% CI, 4.3%-4.7%) at 9 years. The rate of any reoperation, including mesh removal, was 2.6% (95% CI, 2.5%-2.7%) at 1 year, 5.5% (95% CI, 5.4%-5.7%) at 5 years, and 6.9% (95% CI, 6.7%-7.1%) at 9 years.

Conclusions and relevance
Among women undergoing midurethral mesh sling insertion, the rate of mesh sling removal at 9 years was estimated as 3.3%. These findings may guide women and their surgeons when making decisions about surgical treatment of stress urinary incontinence.