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Observational Study
. 2015 Jan;193(1):203-10.
doi: 10.1016/j.juro.2014.08.089. Epub 2014 Aug 23.

5-year longitudinal followup after retropubic and transobturator mid urethral slings

Kimberly Kenton  1 , Anne M Stoddard  2 , Halina Zyczynski  3 , Michael Albo  4 , Leslie Rickey  5 , Peggy Norton  6 , Clifford Wai  7 , Stephen R Kraus  8 , Larry T Sirls  9 , John W Kusek  10 , Heather J Litman  11 , Robert P Chang  2 , Holly E Richter  12
Affiliations
Observational Study

5-year longitudinal followup after retropubic and transobturator mid urethral slings

Kimberly Kenton et al. J Urol. 2015 Jan.

Abstract

Purpose: Few studies have characterized longer-term outcomes after retropubic and transobturator mid urethral slings.

Materials and methods: Women completing 2-year participation in a randomized equivalence trial who had not undergone surgical re-treatment for stress urinary incontinence were invited to participate in a 5-year observational cohort. The primary outcome, treatment success, was defined as no re-treatment or self-reported stress incontinence symptoms. Secondary outcomes included urinary symptoms and quality of life, satisfaction, sexual function and adverse events.

Results: Of 597 women 404 (68%) from the original trial enrolled in the study. Five years after surgical treatment success was 7.9% greater in women assigned to the retropubic sling compared to the transobturator sling (51.3% vs 43.4%, 95% CI -1.4, 17.2), not meeting prespecified criteria for equivalence. Satisfaction decreased during 5 years but remained high and similar between arms (retropubic sling 79% vs transobturator sling 85%, p=0.15). Urinary symptoms and quality of life worsened with time (p <0.001), and women with a retropubic sling reported greater urinary urgency (p=0.001), more negative impact on quality of life (p=0.02) and worse sexual function (p=0.001). There was no difference in the proportion of women experiencing at least 1 adverse event (p=0.17). Seven new mesh erosions were noted (retropubic sling 3, transobturator sling 4).

Conclusions: Treatment success decreased during 5 years for retropubic and transobturator slings, and did not meet the prespecified criteria for equivalence with retropubic demonstrating a slight benefit. However, satisfaction remained high in both arms. Women undergoing a transobturator sling procedure reported more sustained improvement in urinary symptoms and sexual function. New mesh erosions occurred in both arms over time, although at a similarly low rate.

Keywords: stress; suburethral slings; urinary incontinence.

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Figures

Figure 1
Figure 1
Flow Diagram
Figure 2
Figure 2
TreatmentSuccess Rates Over Time for Women Randomized to Retropubic and Transobturator Midurethral Sling (N=583)
Figure 3
Figure 3
Treatment Success and 95% confidence intervals for Retropubic and Transobturator Midurethral Slings at 1, 2, and 5-years after Surgery
See this image and copyright information in PMC

Comment in

References

    1. Oliphant SS, Wang L, Bunker CH, et al. Trends in stress urinary incontinence inpatient procedures in the United States, 1979-2004. American journal of obstetrics and gynecology. 2009;200:521, e1–6. - PMC - PubMed
    1. Erekson EA, Lopes VV, Raker CA, et al. Ambulatory procedures for female pelvic floor disorders in the United States. American journal of obstetrics and gynecology. 2010;203:497, e1–5. - PMC - PubMed
    1. Anger JT, Weinberg AE, Albo ME, et al. Trends in surgical management of stress urinary incontinence among female Medicare beneficiaries. Urology. 2009;74:283–7. - PMC - PubMed
    1. Brubaker L, Richter HE, Norton PA, et al. 5-year continence rates, satisfaction and adverse events of burch urethropexy and fascial sling surgery for urinary incontinence. The Journal of urology. 2012;187:1324–30. - PMC - PubMed
    1. Ward KL, Hilton P. Uk, Ireland TVTTG. Tension-free vaginal tape versus colposuspension for primary urodynamic stress incontinence: 5-year follow up. BJOG : an international journal of obstetrics and gynaecology. 2008;115:226–33. - PubMed

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