Reoperation rates are significantly lower with a retropubic than tranobturator sling procedure for recurrent stress urinary incontinence (SUI), according to new study findings published in Obstetrics & Gynecology.
Of 1881 women who underwent their first midurethral sling procedure for SUI, 1551 had a retropubic and 330 had a transobturator sling placement. Of these, Emanuel C. Trabuco, MD, MS, of Mayo Clinic in Rochester, Minnesota, and colleagues matched 570 patients with retropubic slings to 317 patients with transobturator slings by age, body mass index, preoperative diagnosis, and isolated or combined procedure type.
Patients undergoing a transobturator sling procedure had a 2.4-fold higher risk of reoperation for recurrent SUI than those undergoing a retropubic sling procedure, according to the investigators. Over 8 years, 11.2% vs 5.2%, respectively, required reoperation. The failure rate for the transobturator procedure was even higher among women who had the sling combined with vaginal prolapse repair, Dr Trabuco noted in a Mayo Clinic news release.
The retropubic group had a significantly higher rate of intraoperative complications (13.7% vs 4.7%, respectively), mostly due to bladder perforation (7.0% vs 0.6%, respectively) and hemorrhage (6.5 vs 3.8, respectively). Retropubic sling cases also had a higher risk of sling revision for urinary retention, with rates stabilizing by 5 years at 3.2% vs 0.4%, respectively. All women resumed normal voiding after revision, and none required prolonged catheterization. No cases of vascular or bowel injury or death occurred during follow-up.
“These findings would suggest that the retropubic procedure has better long-term results compared to the transobturator sling,” Dr Trabuco stated in the release. He added that the data should help providers counsel women presenting for surgical treatment of SUI.
Trabuco EC, Carranza D, El Nashar SA, et al. Reoperation for urinary incontinence after retropubic and transobturator sling procedures. Obstet Gynecol. 2019;134:333–342. doi:10.1097/AOG.0000000000003356
Advantages for stress urinary incontinence surgery (news release). Mayo Clinic; July 15, 2019.