Maternal Child Health ‹ Women's Health Notes ‹ Issue 4
Women's Health Notes
Issue 4, July 2010
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Gynecology and Well-Woman Care
Retropubic versus transobturator midurethral slings for stress incontinence
BACKGROUND: Midurethral slings are increasingly used for the treatment of stress incontinence, but there are limited data comparing types of slings and associated complications.
METHODS: We performed a multicenter, randomized equivalence trial comparing outcomes with retropubic and transobturator midurethral slings in women with stress incontinence. The primary outcome was treatment success at 12 months according to both objective criteria (a negative stress test, a negative pad test, and no retreatment) and subjective criteria (self-reported absence of symptoms, no leakage episodes recorded, and no retreatment). The predetermined equivalence margin was +/-12 percentage points.
RESULTS: A total of 597 women were randomly assigned to a study group; 565 (94.6%) completed the 12-month assessment. The rates of objectively assessed treatment success were 80.8% in the retropubic-sling group and 77.7% in the transobturator-sling group (3.0 percentage-point difference; 95% confidence interval [CI], -3.6 to 9.6). The rates of subjectively assessed success were 62.2% and 55.8%, respectively (6.4 percentage-point difference; 95% CI, -1.6 to 14.3). The rates of voiding dysfunction requiring surgery were 2.7% in those who received retropubic slings and 0% in those who received transobturator slings (P=0.004), and the respective rates of neurologic symptoms were 4.0% and 9.4% (P=0.01). There were no significant differences between groups in postoperative urge incontinence, satisfaction with the results of the procedure, or quality of life.
CONCLUSIONS: The 12-month rates of objectively assessed success of treatment for stress incontinence with the retropubic and transobturator approaches met the prespecified criteria for equivalence; the rates of subjectively assessed success were similar between groups but did not meet the criteria for equivalence. Differences in the complications associated with the two procedures should be discussed with patients who are considering surgical treatment for incontinence.
Richter HE, Albo ME, Zyczynski HM, Kenton K, Norton PA, Sirls LT, et al. Retropubic versus transobturator midurethral slings for stress incontinence. N Engl J Med. 2010 Jun 3;362(22):2066-76. Epub 2010 May 17. http://www.ncbi.nlm.nih.gov/pubmed/20479459
Editorial
Rogers RG. What's best in the treatment of stress urinary incontinence? N Engl J Med. 2010 Jun 3;362(22):2124-5. Epub 2010 May 17. http://www.ncbi.nlm.nih.gov/pubmed/20479458
Dyspareunia associated with paraurethral banding in the transobturator sling
OBJECTIVE: We sought to compare the development of paraurethral banding and subsequent dyspareunia in women undergoing either a transobturator (TO) or retropubic (RP) sling.
STUDY DESIGN: We conducted a retrospective cohort study comparing women treated with either a TO or RP sling during a 10-month period.
RESULTS: A total of 25 TO sling patients and 28 RP sling patients were compared in the study. Paraurethral banding was observed in 13/25 (52%) of the TO group compared with none in the RP group (P<.001). Although no difference was noted in overall female sexual function index scores, de novo internal dyspareunia was reported in 4/17 (24%) of the TO group and none in the RP group (P=.04). Paraurethral banding was observed in all patients reporting dyspareunia.
CONCLUSION: We have identified paraurethral banding as a previously unreported complication of the TO sling. Surgeons should be aware of paraurethral banding and subsequent internal dyspareunia as a potential complication.
Cholhan HJ, Hutchings TB, Rooney KE. Dyspareunia associated with paraurethral banding in the transobturator sling. Am J Obstet Gynecol. 2010 May;202(5):481.e1-5. Epub 2010 Mar 15.
http://www.ncbi.nlm.nih.gov/pubmed/20227671
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