(027) Considerations of Mid-Urethral Sling Procedures: Patient and Provider Perspectives on Outcomes and Experiences
Authors: Tomalty D , Giovannetti O , Greco S , Komisaruk B , Hannan J , Goldstein S , Goldstein I , Adams M 
Published: May 2023

Abstract

Introduction
The mid-urethral sling procedure (MUSP) treats symptoms of stress urinary incontinence. Recent studies have identified the potential for negative outcomes following MUSP; however, there is a limited understanding of the patient and healthcare provider perspectives on procedural experiences and outcomes. Specifically, there is discordance surrounding the role of female periurethral tissue in sexual responses, and limited knowledge of post-MUSP outcomes and symptoms as perceived by patients. Further understanding of current counselling and resource practices is needed, especially regarding informed consent and risk disclosure.

Objective
To investigate the experiences associated with MUSP from patients who have reported bothersome symptoms following MUSP, and from providers who routinely perform the procedure. Furthermore, to characterize recent patient experiences, explore factors which may influence current provider decision-making, and outline patient-used and provider-recommended counselling and resources.

Methods
Patients (n=10) who underwent MUSP and reported negative outcomes, and providers (n=22) with experience performing MUSP were recruited. Patients first completed an online survey which captured demographic information, medical history, and sexual function. Both patients and providers completed semi-structured interviews relating to MUSP outcomes and experiences. Interview responses were transcribed using Trint, and qualitative analyses were completed using NVivo 12.

Results
Perspectives and experiences gathered from patient and provider interviews revealed discordant narrative surrounding MUSP outcomes and treatment. Analysis of patient narratives revealed a unique symptom profile including periurethral pain and numbness, altered lubrication and loss of desire. In addition, patients discussed post-MUSP infections, as well as pain, weakness, and lower limb impairment having impacts on and extending to other aspects of life, including social relationships, work obligations, and day-to-day responsibilities. Patients described a preference for informed pre-procedural care, and supportive and comprehensive post-procedural counselling. Provider narratives revealed aims of fostering open discussions and efforts to offer procedural support. However, providers referenced limitations in time, experience, and understanding of the adverse outcome symptom profile. Further, regarding post-procedural care, both providers and patients discussed limitations in currently available counselling routes and resources.

Conclusions
The results of this study highlight discordance between the perceptions of patients and providers regarding MUSP outcomes and experiences. There are differences in the understanding of post-MUSP negative outcome experiences as perceived by patients, compared to providers. These findings support the need for improvements in post-MUSP support and targeted counselling, and resources. Differences in the knowledge of symptoms and negative outcome experiences as related to sexual function are emphasized in this context, highlighting, and encouraging the need for improvements in clinical practice which includes sexual health conversations and accessible resources.

Disclosure
No