5-Year Longitudinal Followup after Retropubic and Transobturator Mid Urethral Slings

Kimberly Kenton, Anne M. Stoddard, Halina Zyczynski, Michael Albo, Leslie Rickey, Peggy Norton, Clifford Wai, Stephen R. Kraus, Larry T. Sirls, John W. Kusek, Heather J. Litman, Robert P. Chang, Holly E. Richter

Research output: Contribution to journalArticle

75 Scopus citations

Abstract

Purpose Few studies have characterized longer-term outcomes after retropubic and transobturator mid urethral slings. Materials and Methods Women completing 2-year participation in a randomized equivalence trial who had not undergone surgical re-treatment for stress urinary incontinence were invited to participate in a 5-year observational cohort. The primary outcome, treatment success, was defined as no re-treatment or self-reported stress incontinence symptoms. Secondary outcomes included urinary symptoms and quality of life, satisfaction, sexual function and adverse events. Results Of 597 women 404 (68%) from the original trial enrolled in the study. Five years after surgical treatment success was 7.9% greater in women assigned to the retropubic sling compared to the transobturator sling (51.3% vs 43.4%, 95% CI −1.4, 17.2), not meeting prespecified criteria for equivalence. Satisfaction decreased during 5 years but remained high and similar between arms (retropubic sling 79% vs transobturator sling 85%, p=0.15). Urinary symptoms and quality of life worsened with time (p <0.001), and women with a retropubic sling reported greater urinary urgency (p=0.001), more negative impact on quality of life (p=0.02) and worse sexual function (p=0.001). There was no difference in the proportion of women experiencing at least 1 adverse event (p=0.17). Seven new mesh erosions were noted (retropubic sling 3, transobturator sling 4). Conclusions Treatment success decreased during 5 years for retropubic and transobturator slings, and did not meet the prespecified criteria for equivalence with retropubic demonstrating a slight benefit. However, satisfaction remained high in both arms. Women undergoing a transobturator sling procedure reported more sustained improvement in urinary symptoms and sexual function. New mesh erosions occurred in both arms over time, although at a similarly low rate.

Original languageEnglish (US)
Pages (from-to)203-210
Number of pages8
JournalJournal of Urology
Volume193
Issue number1
DOIs
StatePublished - Jan 2015

Keywords

  • stress
  • suburethral slings
  • urinary incontinence

ASJC Scopus subject areas

  • Urology

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    Kenton, K., Stoddard, A. M., Zyczynski, H., Albo, M., Rickey, L., Norton, P., Wai, C., Kraus, S. R., Sirls, L. T., Kusek, J. W., Litman, H. J., Chang, R. P., & Richter, H. E. (2015). 5-Year Longitudinal Followup after Retropubic and Transobturator Mid Urethral Slings. Journal of Urology, 193(1), 203-210. https://doi.org/10.1016/j.juro.2014.08.089