Long-term durability of midurethral slings under scrutiny

By Joanna Lyford, Senior medwireNews Reporter

Long-term follow-up of women treated with midurethral slings for stress urinary incontinence (SUI) indicates that continence rates stabilise earlier with use of tension-free vaginal tape (TVT) than with transobturator tape (TOT).

This difference should be highlighted when counselling women about anticipated outcomes, say the researchers, who also observe that adverse events typically occurred within the first 24 months.

The research is reported in a letter published in European Urology and details extended follow-up of 87 women who participated in a randomised controlled trial comparing TVT with TOT for the treatment of female stress urinary incontinence.

“Lack of long-term outcomes is a major debating point in urogynecology, and data on the long-term durability of anti-incontinence procedures are needed because female life expectancy is significantly lengthening in developed countries,” explain Elisabetta Costantini (University of Perugia, Italy) and colleagues. After a median follow-up of 99 months, 59.6% of 47 women treated with TOT were completely dry and 29.8% had objective postoperative incontinence. Four women in this latter group underwent reintervention for recurrent SUI and seven needed surgical revision for mesh exposure, four of whom were subsequently continent.

Of 31 women treated with TOT with preoperative storage symptoms, 71% became asymptomatic at follow-up; however, seven women developed de novo storage symptoms. The 11 women with preoperative voiding symptoms all became asymptomatic after surgery while a further seven developed these symptoms.

The remaining 40 women received TVT and were followed-up for a median of 111 months. In this group, 75.0% were completely continent and 12.5% had objective postoperative incontinence. No woman underwent reintervention although one patient who continued to have symptoms underwent TVT revision.

Preoperatively, 25 women from the TVT group had storage symptoms, 10 of whom became asymptomatic after surgery. Meanwhile, 12 women had preoperative voiding symptoms, which disappeared in nine women after surgery. De novo storage and voiding symptoms developed in two and five women, respectively.

The proportion of women who said they would repeat the surgery was high in both TOT and TVT groups, at 83.0% and 87.5%, respectively.

Interestingly, among women treated with TVT, continence rates declined steadily up to around 25 months after surgery and then stabilised; in women treated with TOT, continence rates continued to decline up to around 72 months.

“These results… could represent an important milestone in properly counselling patients regarding the long-term outcomes of sling procedures,” write the authors.

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