Long-Term Safety and Efficacy of Partially Absorbable Transobturator Mid-Urethral Sling in Women Aged 65 Years and Older

<b>Objectives:</b> To assess the long-term safety and efficacy of the Serasis^® partially absorbable transobturator mid-urethral sling (MUS) in women aged ≥65 years compared to younger women. <b>Methods:</b> A retrospective comparative study of 375 consecutive women who underwent Serasis^® MUS for stress urinary incontinence (SUI). Patients were stratified into two age groups: 45-64 years (N = 118) and ≥65 years (N = 257), with further subdivision of the elderly cohort into 65-74 years (N = 208) and 75-84 years (N = 49). Primary outcomes included perioperative safety and long-term subjective cure rates, assessed via standardized telephone survey at a mean follow-up of 8.5 years (range, 6.8-10.9 years). <b>Results:</b> Perioperative outcomes were comparable across age groups. At 4 months postoperatively, subjective cure was achieved in 82.9% of elderly and 86.4% of younger patients. Long-term subjective cure rates were 79.6% and 85.4%, respectively (<i>p</i> = 0.27). Elderly patients experienced higher rates of postoperative voiding dysfunction and persistent overactive bladder symptoms, though subjective satisfaction remained high. Long-term mesh-related complications were infrequent across age groups. Specifically, vaginal mesh erosion requiring surgical removal occurred in three elderly patients (1.6%) and in only one younger patient (1.1%). A multivariate logistic regression analysis identified preoperative mixed urinary incontinence, BMI >30 kg/m² and concomitant pelvic organ prolapse repair as independent predictors of surgical failure. Age ≥65 years was not an independent predictor of surgical failure (OR 1.3, 95% CI 0.8-2.1, <i>p</i> = 0.31). <b>Conclusions:</b> The use of a partially absorbable MUS in elderly women with SUI is a safe and effective surgical approach, associated with a significant reduction in long-term mesh-related complications.