Journal Article

Retropubic versus Transobturator Midurethral Slings for Stress Incontinence

Nager, Charles W, Richter, Holly E, Brubaker, Linda, Dandreo, Kimberly J, Gormley, E. Ann, Albo, Michael E, Kenton, Kimberly, Holley, Robert L, Zyczynski, Halina M, Khandwala, Salil, Rozanski, Thomas A, Varner, R. Edward, Tennstedt, Sharon, Stoddard, Anne M, Litman, Heather J, Moalli, Pamela, Sirls, Larry T, Chai, Toby C, Corton, Marlene, Arisco, Amy M, Menefee, Shawn, Norton, Peggy A, Lemack, Gary E, Schaffer, Joseph, Ghetti, Chiara, Mueller, Elizabeth, Chang, T. Debuene, Nygaard, Ingrid, Kraus, Stephen R, Johnson, Harry

2010

Overview

This randomized trial comparing retropubic and transobturator slings for the treatment of stress urinary incontinence showed equivalent rates of treatment success according to objective criteria; the rates of treatment success in the two groups according to subjective criteria were similar but did not meet the criteria for equivalence. Complications differed in the two groups, with more voiding dysfunction requiring surgery in the retropubic-sling group and more neurologic symptoms in the transobturator-sling group. In this randomized trial, two surgical approaches for the treatment of stress urinary incontinence had similar cure rates, although the complications differed by group. Urinary incontinence affects up to 50% of women, resulting in substantial medical, social, and economic burdens. 1 , 2 Among U.S. women with urinary incontinence, 15 to 80% have a component of stress incontinence, 3 which results in leakage of urine during physical exertion, sneezing, and coughing. 4 Of these women, 4 to 10% undergo surgery. 5 In 1996, Ulmsten et al. 6 introduced a procedure that involved the placement of a retropubic midurethral mesh sling for the treatment of stress incontinence; this procedure was less invasive than the Burch colposuspension and the autologous rectus fascial sling procedures that were the reference standards at the time. . . .

• Publisher: Massachusetts Medical Society
• Subject: Biological and medical sciences / Comparative Effectiveness Research / Female / Follow-Up Studies / General aspects / Humans / Intention to Treat Analysis / Intraoperative Complications - epidemiology / Medical sciences / Middle Aged / Patient Satisfaction / Postoperative Complications - epidemiology / Postoperative period / Suburethral Slings / Treatment Outcome / Urinary incontinence / Urinary Incontinence, Stress - surgery / Urination Disorders - etiology / Urodynamics / Urologic Surgical Procedures - instrumentation / Urologic Surgical Procedures - methods