Existing stress urinary incontinence (SUI) research focuses on clinical outcomes, which may differ from and overlook key concepts of importance to patients. When patient perspectives are sought, an understanding of what is most important to women, as opposed to the surgeon, is gained. We sought to understand patient experiences including knowledge, attitudes, and beliefs regarding mesh mid-urethral sling (MUS) surgery and outcomes.

Patients who had undergone placement of a mesh MUS between January 2014 and December 2018 at a single institution by one of three female pelvic medicine and reconstructive surgery (FPMRS) specialists were invited by phone call to participate in semi-structured focus groups or individual interviews. Informed consent was obtained from all participants prior to engaging in focus groups or interviews. Discussions were recorded and transcribed. Transcriptions were uploaded into the NVivo software programs. Two investigators individually analyzed data for themes using inductive and deductive content analysis aided by NVivo software, four researchers reached consensus on the themes.

Eleven women participated, mean age 61 years (range 39-88).  A majority of the cohort was white (72%) and non-Hispanic (91%). Themes and illustrative quotations are listed in the table. Women discussed barriers related to undergoing surgical intervention for SUI, such as embarrassment associated with discussing SUI symptoms, encountering physicians who were not empathetic, and personally needing to advocate for themselves for appropriate referrals. Women recounted specific urinary leakage events that led to their decision to pursue surgical intervention for SUI. Most women expressed satisfaction with the improvement in SUI specific symptoms, while others associated non-SUI symptoms with their surgical outcomes, such as changes in bowel habits and urinary frequency. Despite not having complications related to MUS surgery, some women recounted higher than expected post-operative pain levels and surprise by the ability to palpate the sling vaginally.

When seeking care for SUI, women encountered various barriers. De novo non-SUI symptoms were attributed, by many women, to MUS surgery. Appreciating patients’ knowledge, concerns, and expectations regarding SUI can inform FPMRS surgeons on how to better meet patient needs and improve patient understanding when discussing MUS surgery. The themes summarized by this small cohort can serve as topics that can be further explored to help improve the patient experience.

Listening to understand women’s perspectives can improve the informed consent process and surgical counseling for MUS surgery. The themes from this study can be further explored,  ultimately with the goals of improving the patient experience and optimizing outcomes.