Retropubic, transobturator slings show long-term equivalence for SUI

Two minimally invasive surgical procedures for female urinary incontinence offer similar long-term cure rates and high levels of patient satisfaction, follow-up of clinical trial participants has found.

The results, published in European Urology, indicate that retropubic and transobturator sling placement are similarly effective, achieving objective and subjective cure in more than 80% of women who undergo the procedure.

In 2004, Carl Nilsson (Helsinki University Central Hospital, Finland) and team initiated a randomised controlled trial in which they compared retropubic tension-free vaginal tape (TVT) with transobturator tension-free vaginal tape (TVT-O) for the treatment of stress urinary incontinence (SUI) in 268 women.

In all, 254 (94.9%) women returned to the clinic for a 5-year follow-up assessment.

At this point, the proportion of women considered to be objectively cured – ie, a negative stress test, a negative pad test and no retreatment for stress incontinence – was 84.7% in the TVT group and 86.2% in the TVT-O group.

These figures fell slightly, to 81.6% and 80.3%, respectively, when women lost to follow-up were classified as failures.

Subjective cure rates – defined as treatment that completely met the woman’s expectations – were similarly high, at 84.6% in the TVT group and 85.6% in the TVT-O group.

Furthermore, women in both groups showed a significant increase in their condition-specific quality-of-life scores at 5 years versus baseline.

There was a low incidence of de novo urgency incontinence after surgery, at 3.1% with TVT and 2.4% with TVT-O, and 4.7% of women reported experiencing moderate/severe frequency and urgency at 5 years.

However, complication rates associated with the procedure were low, with no difference between groups, and the tape material did not cause any adverse tissue reactions.

Nilsson and co-workers conclude: “The long-term follow-up results of the present randomized trial comparing the retropubic TVT procedure with the inside-out TVT-O procedure reveals no difference in cure rate or complication rate between the two operations.”

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